Guillain-Barré syndrome (GBS) is an acute immune-mediated neuropathy, classically defined by ascending paralysis, sensory disturbances, and hypo- or areflexia. However, there have been reported cases of GBS with hyperreflexia in Asian and European countries, particularly in association with the axonal variant and/or positive anti-ganglioside antibodies. Magnetic stimulation studies have previously shown evidence of corticospinal tract involvement with significantly delayed central motor conduction time in these patients. In contrast, AIDP, the most prevalent form of GBS in North America, is less known to be associated with hyperreflexia; only a few adult cases have been reported in the literature thus far. 

We report a case of a 54-year-old Caucasian male who presented with progressive ataxia and symmetrical, ascending generalized weakness over a 14-day period before reaching a plateau.  His symptoms were preceded by a viral-like illness one week prior.

Although the majority of the reported cases of GBS with hyperreflexia are associated with an axonal variant and/or positive anti-ganglioside antibodies, an antibody-negative demyelinating variant can also present similarly. It is, therefore, important to raise awareness of such an atypical clinical feature in GBS patients to avoid delays in treatment.