Atypical Asymmetric Guillain-Barré Syndrome Overlapping with Miller-Fisher Syndrome: A Case Report
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Guillain-Barré syndrome (GBS) is an acute immune-mediated polyneuropathy that constitutes a heterogeneous syndrome with several variant forms. We experienced a patient who rapidly developed atypical variant GBS without a preceding history of infection. A 13-year-old female patient was admitted, presenting with left facial palsy and ophthalmoplegia. After a few days, right hand and ankle muscle weakness and paresthesia of both hands newly occurred. Electrophysiological findings revealed multifocal asymmetric motor and sensory axonal neuropathies compatible with multiple mononeuropathy. In blood testing, autoimmune-related antibodies were negative and anti-GQ1b antibodies were positive. We diagnosed the patient with overlapping Miller-Fisher syndrome and the acute motor sensory axonal neuropathy variant of GBS. After intravenous immunoglobulin therapy, the weakness of the limbs partially improved. Since the initial symptoms were similar to those of mononeuritis multiplex, it was difficult to recognize GBS. Electrodiagnostic studies and anti-ganglioside antibody screening tests are necessary for the early differential diagnosis of variant GBS.
Abstract
Guillain-Barré syndrome (GBS) is an acute immune-mediated polyneuropathy that constitutes a heterogeneous syndrome with several variant forms. We experienced a patient who rapidly developed atypical variant GBS without a preceding history of infection. A 13-year-old female patient was admitted, presenting with left facial palsy and ophthalmoplegia. After a few days, right hand and ankle muscle weakness and paresthesia of both hands newly occurred. Electrophysiological findings revealed multifocal asymmetric motor and sensory axonal neuropathies compatible with multiple mononeuropathy. In blood testing, autoimmune-related antibodies were negative and anti-GQ1b antibodies were positive. We diagnosed the patient with overlapping Miller-Fisher syndrome and the acute motor sensory axonal neuropathy variant of GBS. After intravenous immunoglobulin therapy, the weakness of the limbs partially improved. Since the initial symptoms were similar to those of mononeuritis multiplex, it was difficult to recognize GBS. Electrodiagnostic studies and anti-ganglioside antibody screening tests are necessary for the early differential diagnosis of variant GBS.
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