PP08.7 – 2364: Atypical Guillain Barré syndrome with preserved deep tendon reflexes: report of three cases

Abstract

Objective Guillain Barre syndrome is a postinfectious polyneuropathy involving mainly motor but sometimes also sensory and autonomic nerves. Guillain Barre syndrome is now the world's most common cause of acute neuromuscular paralysis. Methods We present here 3 patients with preserved deep tendon reflexes. Case 1: An 11 year-old girl was admitted with a complaint of weakness confined to the lower extremities and in a lesser extent to the upper extremities over 4 days. On physical examination muscle strength was 2/5 on lower extremities and 4/5 in upper extremities. Case 2: A 17-year-old boy with known spondylarthritis presented with complaints of weakness of lower extremities over 10 days. On physical system examination muscle strength was 4/5 on lower extremities and 5/5 on upper extremities. Case 3: A 9-year-old boy was admitted with weakness and pain in the lower extremities over 10 days. His CK was 2988 (150–499 U/L). He was diagnosed as myositis and painkillers were prescribed. Then the weakness gradually worsened involving upper extremities. On physical system examination muscle strength was 4/5 on lower extremities and 2/5 on upper extremities. Results The deep tendon reflexes were normal in upper and lower extremities on repeated examinations in all of 3 cases. The diagnosis of Guillain Barre Syndrome was made by electrophysiological studies. Conclusion Although hypo- or areflexia is necessary for clinical diagnosis of GBS, preserved deep tendon reflexes do not exclude the diagnosis of Guillain-Barre syndrome. The electrophysiological studies play a very important role in differentiating it from other causes.