Introduction:
Guillain–Barre syndrome (GBS) is an acute immune-mediated inflammatory
demyelinating polyneuropathy, and it is the most common cause of acute
flaccid paralysis worldwide.
It is occurring with an overall incidence of 1 to 2 cases per 100,000
people per year. The disease’s incidence rises by about 20% every
decade of age, and males are more likely to contract it than females
[1].
It mainly affects most of the spinal nerve roots and peripheral nerves
and often involves the cranial nerves and is characterized by
symmetrical limb weakness and areflexia [2].
Most patients present with an antecedent illness, most commonly an upper
respiratory tract infection or diarrheal illness, before the onset of
progressive motor weakness. Several microorganisms have been associated
with Guillain-Barré syndrome, most notably Campylobacter jejuni, Zika
virus, influenza, Mycoplasma pneumoniae, and cytomegalovirus. and in
2020, the severe acute respiratory syndrome coronavirus [3].
Diagnostic criteria for GBS were originally proposed for research in
1978 by the National Institute of Neurological Disorders and Stroke
(NINDS). Including, acute progressive and symmetric muscle weakness with
absent or depressed deep tendon reflexes [4].
The weakness can vary from mild difficulty with walking to nearly
complete paralysis of all extremities, including facial, respiratory,
and bulbar muscles. Symptoms typically progress over days to four weeks.
Patients may also have mild sensory symptoms and dysautonomia.
Lumbar puncture for CSF analysis should be performed in all patients to
confirm the GBS diagnosis and exclude other sources of the symptoms.
With a typical finding of an elevated CSF protein with a normal white
blood cell count.
Electrodiagnostic studies consisting of nerve conduction studies (NCS)
and electromyography (EMG) are performed in most patients to support the
diagnosis of GBS as well as to provide prognostic information regarding
the nature and severity of nerve dysfunction.
Multiple variants of GBS have been described. Here we will present a
rare case of GBS that presented with lower limb weakness, areflexia, and
atypical sensory level.