Pharyngeal-Cervical-Brachial Variant of Guillain-Barre Syndrome

Abstract

Guillain-Barre syndrome (GBS) is the most common cause of acute neuromuscular paralysis in the Western world. We describe the only known case presentation of pharyngeal-cervical-brachial variant following a subacute myocardial infarction and Vibrio cholerae vaccination. A 55-year-old Filipino man presented to our emergency department with a one-day history of progressive oropharyngeal and cervicobrachial weakness and areflexia in the upper limbs. His review of systems was unremarkable except for receiving “Dukoral” traveller’s diarrhea vaccine 3 weeks prior. His physical exam was compatible with GBS. EMG and nerve conduction studies showed low motor amplitudes, prolonged distal latency and absent F-waves in the arms. Lumbar puncture showed a protein level of 579 mg/L. Nuclear perfusion scan was consistent with a subacute myocardial infarction. He received a 2-day course of intravenous immunoglobulin. He showed significant improvement in his weakness over 3 days. Recent vaccination and myocardial infarction may be important triggers for GBS onset. J Neurol Res. 2014;4(2-3):88-90 doi: http://dx.doi.org/10.14740/jnr270w