Acute bilateral vision deficit as the initial symptom in Guillain-Barre syndrome: A case report

Abstract

Guillain-Barre syndrome (GBS) is a rare autoimmune-mediated peripheral neuropathy with an acute onset. GBS is associated with posterior cranial nerve injury including the facial, oculomotor, glossopharyngeal and vagus nerves. A 43-year-old female presented with worsening blurred binocular vision accompanied by diplopia, bilateral ptosis, speech difficulties, dysphagia, extremity numbness and weakness of the limbs. A neurological examination was conducted along with magnetic resonance imaging of the brain and spinal cord, electromyography, cerebrospinal fluid analysis and visual evoked potential tests, which led to a diagnosis of GBS. Following immunoglobulin administration, the patient's neurological deficiencies were markedly relieved and they were discharged following a 3-week observation period. To the best of our knowledge, this is the first reported case of GBS associated with cranial nerve damage presenting with bilateral visual deterioration as the initial symptom. It is necessary to emphasize that early diagnosis and commencing the immunological treatment in a timely manner resulted in a favorable prognosis for the patient.

Keywords: Guillain-Barre syndrome; autoimmune polyneuropathy; multiple cranial nerve damage; visual deterioration.

Figure 1.

Cerebral cervical spine MRI of a 43-year-old female with Guillain-Barre syndrome presenting with acute bilateral vision deficit. (A-F) Brain MRI indicated bilateral hemispheric symmetry and no focal abnormalities of signal. The ventricles of the brain, midline structures, subtentorial cerebellar and brainstem appeared normal. (G) A sagittal scan revealed normal shape and size of the brainstem and pituitary. (H) Cervical MRI indicated normal cervical sequence. The physiological curvature of the cervical spine appeared normal, the spinal cord had no abnormal changes and no stenosis. MRI, magnetic resonance imaging.

Figure 2.

Bilateral VEP of a 43-year-old female affected by Guillain-Barre syndrome prior to treatment. (A) Tabular numerical indicated impaired binocular vision with prolonged latency of the bilateral full-field and decreased amplitude. (B) The pattern reversal of VEP for the left eye. N75 waves demonstrated normal latency while the P100 and N145 waves had prolonged latency. (C) The pattern reversal of VEP for the right eye. P100, N145 and N75 waves from the right eye displayed prolonged latency and poor differentiation. VEP, visual evoked potential.

Figure 3.

Bilateral VEP of a 43-year-old female with Guillain-Barre syndrome following treatment. (A) Tabular numerical indicated restored binocular vision with normal latency of the bilateral full-field and normal amplitude. (B) The pattern reversal of VEP for the left eye. N75, P100 and N145 waves demonstrated normal latency and amplitude. (C) N75, P100 and N145 waves from the right eye displayed normal latency and amplitude. VEP, visual evoked potential.