Dr. Raghavi A Bembey, Dr. Paras Passi and Dr. VK Rastogi
Guillian-Barre Syndrome (GBS) presents typically as ascending symmetrical flaccid muscle weakness, with or without sensory symptoms and areflexia. In some patients it may present atypically as one of the multiple variants of GBS which are known. Pharyngeal-cervical-brachial variant is a rare variants and it is characterized by involvement of weakness of muscle of oropharyngeal, neck and proximal upper extremities, which may further progress to rare pattern of descending paralysis. Pharyngeal -cervical-brachial and descending paralysis variant is an unfamiliar entity, very often misdiagnosed as botulism, myasthenia gravis and brainstem stroke, causing undue delay in treatment leading to bad outcomes. This is a case report of the rare pharyngeal-cervical-brachial variant of GBS progressing to descending paralysis. A 32-year-old Indian male presented with weakness of dysphagia, bilateral upper limb and nasal intonation of voice which later involved his trunk and lower limbs. A diagnosis of pharyngeal-cervical-brachial variant of GBS with descending paralysis pattern was made after exclusion of other differentials based on clinical history, examination, cerebrospinal fluid analysis and nerve conduction study. The patient improved significantly with immunoglobulin therapy with no neurological deficit. Pharyngeal-cervical-brachial variant of GBS should be considered a differential in any patient presenting with bulbar palsy and symmetrical upper limb weakness. This is to ensure early diagnosis, treatment, and follow-up of the potential complications.
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