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Case Reports
. 2023 Dec 8;15(12):e50184.
doi: 10.7759/cureus.50184. eCollection 2023 Dec.

Paradoxical Hyperreflexia in a Patient With Classic Guillain-Barré Syndrome

Quang Nguyen  1 , Cynthia Janku  1 , Michelle Tan  1 , Rachel Hunsucker  1 , Jeffrey J Li  1 , Tehmina Salahuddin  2
Affiliations
Case Reports

Paradoxical Hyperreflexia in a Patient With Classic Guillain-Barré Syndrome

Quang Nguyen et al. Cureus. .

Abstract

Background: Guillain-Barré syndrome (GBS) is a rare entity with characteristic features, including progressive ascending paralysis. Patients typically present with progressive symmetrical weakness with areflexia in bilateral lower extremities, which can be confounded by psychiatric comorbidities. This case is unusual in that the patient had paradoxical hyperreflexia and normal CSF protein levels during her initial presentation, later confirmed to be GBS.

Case presentation: Here, we describe the case of a young female with bipolar disorder who presented to the hospital with complaints of week-long bilateral lower leg weakness that started abruptly about a month after an episode of multiple stools of bloody diarrhea. The initial neurological exam revealed 4/5 bilateral lower extremity strength and near global areflexia, excluding a 3+ right patellar reflex, and CSF studies returned normal CSF protein levels. Based on the clinical presentation of worsening ascending paralysis, electromyography (EMG) findings, and nerve conduction studies (NCS) consistent with an axonal and demyelinating neuropathy, we diagnosed her with the classic form of Guillain-Barré syndrome with paradoxical hyperreflexia. Imaging results, laboratory findings, treatment decisions, and outcomes of this case are presented.

Keywords: clinical electro-diagnostics; guillain-barre syndrome (gbs); guillian-barre syndrome; lumbar puncture (lp); nerve conduction studies (ncs).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. MRI of the brain showed no acute cortical abnormalities.
Figure 2
Figure 2. MRI lumbar spine: there are posterior protrusions at the L3-4 through L5-S1 levels. There is no spinal canal stenosis. There is mild to moderate left L5-S1 neural foramen narrowing.
Figure 3
Figure 3. Unremarkable MRI cervical spine.
Figure 4
Figure 4. Nerve conduction study waveforms
Figure 5
Figure 5. Nerve conduction study waveforms, continued
See this image and copyright information in PMC

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