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Review
. 2023 May;44(5):1563-1574.
doi: 10.1007/s10072-022-06580-0. Epub 2022 Dec 30.

Co-occurrence of polyneuritis crainials and visual impairment: a case report and literature review

Hui Li  1 , Zhijun Li  1 , Bo Huang  2 , Na Tang  1 , Shabei Xu  1 , Wenhao Zhu  3
Affiliations
Review

Co-occurrence of polyneuritis crainials and visual impairment: a case report and literature review

Hui Li et al. Neurol Sci. 2023 May.

Abstract

Background: Polyneuritis cranialis (PNC) with the disease characteristics of Guillain-Barré syndrome (GBS) in addition to both ocular and bulbar weakness in the absence of limb paralysis or ataxia is defined as an unusual variant of GBS. As evidence of central nervous system (CNS) involvement, visual impairment is an unusual finding complicating with GBS spectrum disorders and has never been reported in patients with PNC.

Methods: We describe a very rare case who clinically presented with progressive multiple cranial nerve palsy and visual impairment. Furthermore, a literature search of concurrent GBS and optic neuritis (ON) as well as PNC attributed to GBS was conducted.

Results: A diagnosis of PNC was considered due to the typical clinical characteristics as well as the presence of cerebrospinal fluid cytoalbumin dissociation and serum antibodies against gangliosides. The clinical manifestations and the bilateral optic nerve involvement in brain magnetic resonance imaging further suggested possible optic neuritis (ON). The patient received treatment with intravenous immunoglobulin followed by short-term use of corticosteroids and finally achieved a full recovery. Thirty-two previously reported cases (17 women, mean age 40) of concurrent GBS and ON and 20 cases of PNC (5 women, mean age 40) were analyzed. We further provided a comprehensive discussion on the potential etiologies, clinical features, therapeutic strategies, and prognosis.

Conclusions: This rare case with the co-occurrence of PNC and visual impairment and the related literature review may help clinicians advance the understanding of GBS spectrum disorders and make appropriate diagnoses and treatment decisions for the rare variants and CNS complications of GBS.

Keywords: Anti-ganglioside antibodies; Guillain-Barré syndrome; Literature review; Optic neuritis; Polyneuritis cranialis; Wakerley classification.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Representative waveforms of the VEP. Checkerboard-stimulation VEP shows bilateral severe prolonged P100 latency with discrete amplitude, 11 days after neurological event initiation
Fig. 2
Fig. 2
Brain MRI of the present case. A, B Axial and coronal MR images show slightly increased signals (arrows) in the bilateral optic nerves without enhancement (C). D No other abnormalities are noted by brain MRI
See this image and copyright information in PMC

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