Abstract

Guillain-Barré syndrome (GBS) is an acute postinfectious polyneuropathy characterized by symmetric and ascending flaccid paralysis. GBS most commonly presents with symmetrical proximal muscle weakness of the lower extremities as the first sign and moves upwards as ascending paralysis. This case presented with asymmetrical descending paralysis and altered sensorium, which made the initial diagnosis quite challenging. CSF reports revealed an albuminocytologic dissociation that supported the diagnosis of post-infectious Guillain-Barré syndrome. Nerve conduction studies revealed an abnormal with increased F wave latency, suggestive of right upper limb sensory and lower limb motor axonal and demyelinating neuropathy. The patient was treated with IVIG and other supportive treatment. The patient showed significant improvement within two weeks. Background: Guillain-Barré syndrome (GBS) can be described as a collection of clinical syndromes that manifests as an acute inflammatory polyradiculoneuropathy with resultant weakness and diminished reflexes. Rarely does the disease manifest with descending paralysis. We present a case of GBS that on the initial presentation had symptoms of altered sensorium and asymmetrical descending paralysis. Objective: An unusual presentation Conclusions: Guillain Barre Syndrome often presents with a wide range of symptoms, although it usually presents with symmetrical ascending paralysis, this case presented with asymmetrical descending paralysis and altered sensorium, which made the initial diagnosis quite challenging.

Keywords: Acute inflammatory demyelinating polyneuropathy; Acute motor axonal neuropathy; Acute paralytic neuropathy; Guillain–Barré syndrome; IVIG; Autoimmune