Abstract Details

Title Guillain Barre Syndrome Variant with Facial Diplegia and Paresthesias presenting with Bulbar Weakness

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 12-018

Objective NA

Background Bifacial weakness with paresthesias is a subtype of Guillain-Barré syndrome (GBS) characterized by rapidly progressive bilateral facial weakness in the absence of other cranial neuropathies, ataxia, or limb weakness. Many patients also complain of distal limb paresthesias and display diminished or absent deep tendon reflexes. We describe a case of GBS with facial diplegia and paresthesias who presented with bulbar weakness.

Design/Methods We describe a 49 year male with no significant past medical history who presented with rapidly progressive dysarthria and dysphagia of four days duration. His symptoms were associated with bilateral finger numbness. On neurological examination, his mental status was intact. He was noted to have bilateral facial weakness worse on the right compared to the left. He had significant dysarthria secondary to lack of tongue movement bilaterally. Muscle strength was intact in the neck and extremities. Sensation was intact and reflexes were present. Coordination and gait were unremarkable.

Results Cerebrospinal fluid analysis revealed mildly elevated proteins with normal cell count. Extensive workup for infectious and inflammatory etiologies including sarcoidosis, Lyme, myasthenia, GM1 antibodies were unremarkable. Imaging of brain and spine did not reveal any abnormalities. Electrodiagnostic studies revealed bilateral facial neuropathy. On further work up, patient was noted to have elevated titres of GQ1b antibodies and Campylobacter jejuni antibodies. He responded well to treatment with IVIG and speech therapy with improvement in dysarthria, dysphagia and paresthesias.

Conclusions We report a rare case of GBS variant with unusual presentation pattern. Our case of facial diplegia with paresthesias presented with rapidly progressive bulbar pattern of weakness. On exam he was noted to have multiple cranial neuropathies with intact muscle strength and reflexes. To our knowledge this rare pattern of GBS variant has not been described before.

Authors/Disclosures
Bhavesh Trikamji, MD (University of California Los Angeles) PRESENTER	Dr. Trikamji has nothing to disclose.
Margaret Adler, MD (Harbor UCLA Department of Neurology)	Dr. Adler has nothing to disclose.

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