To present an atypical case of an acute acquired polyneuropathy with marked persistent asymmetric changes with initially preserved deep tendon reflexes, simulating a cerebrovascular event.

Guillain-Barré syndrome (GBS) is an immune mediated polyneuropathy. Multiple clinical variants of GBS have been identified. Among these is the Acute Motor Axonal Neuropathy (AMAN) which is characterized by selective involvement of motor nerves and axonal involvement with sensory sparing on electrophysiological studies. It is commonly preceded by diarrheal illness by Campylobacter jejuni, and associated with anti-GM1 antibodies. It’s typical presentation consists of symmetric ascending tetraparesis. We present a very rare case of asymmetric AMAN, very few cases have been reported in the adult population.

Case of a 54y/o male patient with past medical history of hypertension, hyperlipidemia and diabetes mellitus type-2, who presents with acute onset right-sided weakness. Initially managed as suspected cerebrovascular accident, admitted for stroke workup, which returned unremarkable. During inpatient rehabilitation patient continued with progressive unilateral weakness, right lower extremity radiculopathic pain, and eventual ipsilateral loss of deep tendon reflexes with impaired ambulation. Initially suspected radiculopathic origin of symptoms. Cervical and lumbar MRIs with degenerative changes. Electrodiagnostic studies performed and interpreted as a motor axonal neuropathy. Further history, revealed profuse acute watery diarrhea 2 weeks prior onset of symptoms. Lumbar puncture performed and with evidence of albuminocytologic dissociation. Patient with positive titers for Campylobacter jejuni and anti-GM1 antibodies. Electrodiagnostic study repeated and with findings of worsening motor axonal neuropathy. Diagnosis of AMAN done, patient received IVIGs with significant clinical improvement. 

Marked persistent asymmetry is one of the features casting doubt for excluding an acute acquired polyneuropathy. The goal with this case is to create awareness of GBS clinical heterogeneity and promote early diagnosis and treatment to improve clinical outcome.