Case Report: Early-Onset Guillain-Barre Syndrome Mimicking Stroke

Abstract

Introduction: Guillain-Barre syndrome (GBS) is an acute immune-mediated inflammatory demyelinating polyneuropathy characterized by symmetrical limb weakness and areflexia. GBS can have different clinical manifestations; hence, the initial symptoms are also varied. Here, we describe a rare case of GBS presenting as hemiparesis and cranial nerve palsy, which mimic brainstem stroke. Case Presentation: A 53-year-old man was admitted to the hospital with a 3-h history of left-arm weakness, glossolalia, and right eyelid droop. After admission, his condition suddenly worsened, with quadriplegia, bilateral peripheral facial palsy, bilateral ophthalmoplegia, and other neurological symptoms. Based on the findings from a neurological examination, MRI, cerebrospinal fluid analysis, and nerve conduction study, a diagnosis of GBS was made. He received intravenous immunoglobulin (0.4 kg/day) for 5 days. After 20 days of systematic therapy, his dysphagia, dyspnea, facial paralysis, ocular movement disorder, and leg weakness recovered almost completely, but his arms were still moderately impaired, with a power of 4/5. Fortunately, the patient recovered well without any sequelae after 2 years of follow-up. Conclusions: In patients with an atypical presentation, the diagnosis of GBS is often delayed. With this case report, we intend to highlight the fact that some symptoms mimicking stroke may be a feature of GBS at onset; close observation and timely diagnosis are crucial for clinicians. Neuroimaging is a valuable diagnostic tool in differentiating stroke from GBS.

Keywords: Guillain-Barre syndrome; IVIg; MRI; anti-GQ1b; stroke.

Figure 1

Magnetic resonance imaging and magnetic resonance angiography of the patient brain revealed normal. (A) T1 sequence; (B) T2 sequence; (C) fluid-attenuation inversion recovery (FLAIR) sequence; (D) diffusion-weighted (DWI) sequence; (E) apparent diffusion coefficient (ADC) sequence; (F) magnetic resonance angiography.

Figure 2

Nerve conduction study (NCS) of the patient showed: the sensory conduction velocity and amplitude of the median nerve, ulnar nerve and sural nerves were normal bilaterally; the motor conduction velocity of bilateral median nerve and right peroneal nerve was normal while the amplitude was reduced; the motor conduction velocity of ulnar nerve was normal bilaterally, while the amplitudes were reduced; the motor conduction velocity and amplitude of the bilateral tibial nerve and left peroneal nerve were normal; the latency and occurrence rate of the F wave in the right ulnar nerve were normal; the latency of the F wave in left median nerve and ulnar nerve was normal, while the occurrence rate was reduced; and the F wave in the right median nerve was absent; the motor conduction velocity of the bilateral facial nerve was normal while the amplitude was reduced.