Guillain-Barre Syndrome Presenting with Perioral Numbness Followed by Diffuse T-Wave Inversion (P06.146)

Abstract

Objective: To describe a case of Guillain-Barre syndrome (GBS) presenting with perioral numbness and T-wave inversion on electrocardiogram (EKG). Background This is the first case report of a patient with GBS presenting with cranial nerve involvement followed by EKG abnormalities. It emphasizes the importance of close monitoring of these patients with rapidly progressing autonomic dysfunction and potentially fatal cardiac arrhythmias. Design/Methods: Case report. Results: A 59 year-old male with a recent diagnosis of sarcoidosis, presented with perioral numbness followed two days later by progressive lower extremity weakness for which he presented to the emergency room. Cerebrospinal fluid (CSF) revealed albumino-cytological dissociation with protein of 94 mg/dl. Telemetry showed diffuse T-wave inversion. He denied cardiac symptoms and prior EKG9s were normal. He didn9t have any past medical or family history of coronary artery disease. Physical examination: he was hypertensive (160/80-90), HR 40-50. Cardiovascular exam was normal. Neurological exam revealed mild dysarthria, weakness 4/5 in both proximal and distal muscles bilaterally. Reflexes were absent throughout. EKG showed sinus bradycardia, prolong QT interval and T-wave inversions in the inferior and anterolateral leads. An echocardiogram showed normal left ventricular systolic function. Cardiac enzymes were normal. Nerve conduction studies showed prolonged distal latencies, partial conduction block, temporal dispersion, absent F-waves and reduced recruitment on needle electromyography all consistent with an acquired demyelinating polyneuropathy i.e. GBS. He was treated with IVIG for 5 days. Neurosarcoidosis was ruled out after extensive evaluation including MRIs of brain, T-spine and L-spine; which were all unremarkable. He was discharge to acute rehab. At one month follow-up his dysarthria and extremity weakness had resolved. Conclusions: Cardiovascular abnormalities in GBS are attributed to autonomic neuropathy and can be seen in up to 2/3 of affected patients. Early recognition, close monitoring and immediate treatment may prevent these potentially fatal complications. Disclosure: Dr. Rivera-Lara has nothing to disclose. Dr. Salameh has nothing to disclose.