P-NE006. Atypical presentation of Guillain-Barré syndrome (GBS) in acute inflammatory demyelinating polyneuropathy (AIDP) with conduction block and its association with anti-sulfatide antibody: A case report

Abstract

Introduction. AIDP represents a subtype of GBS, whereby demyelination impairs transmission of impulse via altered paranodal and internodal membranes. Conduction blocks and velocity reduction occurs as a result in which our case illustrates. Results. A 63-year-old Chinese retired salesman with dyslipidemia presented with sudden limb weakness and slurring of speech. He experienced fever, lethargy and flu-like symptoms two days prior. On arrival, temperature was 38.8 degrees Celsius while other vital signs were within normal limits. He was oriented with left lower motor seventh nerve lesion and dysarthria. Other cranial nerve functions were intact. Both upper limbs had power of 4/5 except for a left wrist drop while lower limbs had power of 3/5 proximally and 4/5 distally except for a right foot drop. Reflexes were present and sensation was intact. Computed tomography of the brain with perfusion study was normal. He was treated as lacunar stroke with NIHSS 8/42 and initiated on antiplatelet. Nerve conduction study (NCS) done in view of patchy clinical distribution shows evidence of generalized motor demyelinating polyneuropathy with multifocal conduction block suggestive of AIDP variant of GBS. A lumbar puncture performed revealed cytoalbuminologic dissociation with cerebrospinal fluid (CSF) protein of 726 mg/L and absence of cells. Meningitis panels were negative and his antiganglioside antibodies demonstrated borderline positivity of anti-sulfatide IgG. Intravenous immunoglobulin (0.4 g/kg) was administered over 5 days. He was discharged and regained full power of both upper and lower limbs. Ensuing NCS at three weeks revealed minimal improvement with return of F-waves recording. Conclusion. GBS presents in myriad of ways underlining the importance of electrophysiological studies. Our patient presented with debilitating symptoms but regained full function after intravenous immunoglobulin. Sensory impairment of varying degree has been observed in raised titres of anti-sulfatide antibodies. Further studies to define phenotype of GBS with anti-sulfatide antibodies are recommended.