An unusual case of recurrent Guillain-Barré syndrome with normal cerebrospinal fluid protein levels: a case report

Introduction: Guillain-Barré syndrome is an acute/subacute set of clinical features of immune mediated polyradiculoneuropathy, typically after respiratory or gastrointestinal viral infection. In this scenario, we described a case of the syndrome mentioned after infection by sars-cov-2 virus. Objectives and Methods: Description of a clinical case after analysis of medical history and complementary exams, in addition to literature review. Design and Setting: Case report, type of descriptive study, developed in the Institute of Medical Assistance to the State Public Servant of São Paulo. Results: A 68-year-old female patient with clinical and laboratory diagnosis of coronavirus infection, hospitalized in need of oxygen supplementation, which evolved after twelve days of symptoms with hypoesthesia on legs and feet and progressively ascending and symmetrical flaccid paraparesis that led to tetraparesis. Neurological examination showed tetraparesis (muscle strength: grade III in MMSS and grade II in MMII), hyporeflexia in MMSS and reflexes abolished in the lower limbs, plantar skin reflex in flexion in both feet, preserved facial mimicry. About complementary tests, it presented cerebrospinal fluid with albuminocytologic dissociation (cell: 1, protein: 89, glucose: 86), RT-PCR for sars-cov-2 research in cerebrospinal fluid, inconclusive, in addition to four-limb electroneuromyography performed after 19 days of onset of neurological condition, indicated polyradiculoneuropathy with involvement of sensory and motor fibers, primarily demyering. Treatment with human immunoglobulin 400 mg/kg/day for 05 days was started. The reported patient was dismissed from the hospital with significant improvement, presenting muscle strength: grade V in MMSS and grade IV in MMII and already with the ability to walk. Conclusions: the case describes a classic neurological complication associated with a virus that was once non-circulating, but currently with a big clinical relevance.

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Cerebrospinal fluid protein in Guillain–Barré syndrome: Need for age‐dependent interpretation

European Journal of Neurology ◽

10.1111/ene.14600 ◽

2020 ◽

Author(s):

Harald Hegen ◽

Felix Ladstätter ◽

Gabriel Bsteh ◽

Michael Auer ◽

Klaus Berek ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Guillain Barre Syndrome ◽

Guillain Barré Syndrome ◽

Age Dependent ◽

Guillain Barré ◽

Cerebrospinal Fluid Protein

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A case of influenza vaccination induced Guillain Barré syndrome with normal cerebrospinal fluid protein and improvement on treatment with corticosteroids

Scandinavian Journal of Infectious Diseases ◽

10.1080/00365540510038974 ◽

2005 ◽

Vol 37 (8) ◽

pp. 621-623 ◽

Cited By ~ 2

Author(s):

Thomas Eckert ◽

Claudius Bartels ◽

Christian Mawrin ◽

Helmut Feistner ◽

Tobias Welte

Keyword(s):

Cerebrospinal Fluid ◽

Influenza Vaccination ◽

Guillain Barre Syndrome ◽

Guillain Barré Syndrome ◽

Guillain Barré ◽

Cerebrospinal Fluid Protein

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Descending paralysis as an atypical presentation of Guillain–Barré Syndrome

SAGE Open Medical Case Reports ◽

10.1177/2050313x20986662 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2098666

Author(s):

Ala Mustafa ◽

Babajide Adio ◽

Alireza Yarahmadi

Keyword(s):

Case Report ◽

Lower Extremity ◽

Clinical Case ◽

Unusual Case ◽

Guillain Barre Syndrome ◽

Atypical Presentation ◽

Rare Presentation ◽

Guillain Barré Syndrome ◽

Guillain Barré ◽

Tendon Reflexes

We herein report a case of a 55-year-old man with an unusual case of Guillain–Barré Syndrome. Its presentation is usually a progression of symmetric muscle weakness that is ascending from the lower extremities making its way more proximal and accompanied by absent or depressed tendon reflexes. Here, the patient exhibited a rare presentation of Guillain–Barré syndrome, where the weakness was ascending upper extremity and descending lower extremity paralysis. The objective of this clinical case report is to highlight this extremely rare descending paralysis presentation of Guillain–Barré Syndrome.

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Peculiar Presentation of COVID-19: A Case Report of Concurrent Stroke and Guillain–Barré Syndrome

Case Reports in Neurological Medicine ◽

10.1155/2021/8824512 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Behnaz Ansari ◽

Helia Hemasian

Keyword(s):

Case Report ◽

Respiratory Distress ◽

Unusual Case ◽

Inflammatory Responses ◽

Neurological Complications ◽

Guillain Barre Syndrome ◽

Nasopharyngeal Swab ◽

Guillain Barré Syndrome ◽

Guillain Barré ◽

Chest Ct Scan

Background. Coronavirus disease 2019 (COVID-19) is a newly recognized infectious disease that has turned into a pandemic. There are few studies reporting Guillain–Barré syndrome (GBS) and stroke separately associated with COVID-19. In this study, we report an unusual case of COVID-19 with stroke and GBS concurrently. Case Report. A 59-year-old woman presented with left-sided weakness of two weeks’ duration followed by right-sided weakness and foot paresthesia. She also complained of cough, myalgia, and respiratory distress of three weeks’ duration. On examination, the patient had respiratory distress. The limb examination revealed asymmetric weakness. All limb reflexes were absent. Pinprick sensation was impaired. The chest CT scan and PCR of nasopharyngeal swab confirmed the diagnosis of COVID-19. Further evaluation revealed acute cerebral infarction and GBS. Consequently, the patient was treated by plasmapheresis, and her symptoms partially improved. Conclusion. According to reports, 36.4% of COVID-19 cases display neurological complications. The neurological manifestations of the disease can involve both the central and peripheral nervous systems. Previously, a few cases of GBS and cerebrovascular disease have been reported in association with COVID-19 separately, while in the present case, CNS and PNS involvement occurred concurrently. It is hypothesized that this concurrence is related to the imbalance of the systemic inflammatory responses and blood vessel autonomous dysfunction.

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