Guillain-Barré Syndrome: A Variant Consisting of Facial Diplegia and Paresthesia with Left Facial Hemiplegia Associated with Antibodies to Galactocerebroside and Phosphatidic Acid

Abstract

Patient: Male, 54Final Diagnosis: Guillain-Barré syndromeSymptoms: Paresthesia of extremities • unilateral facial palsyMedication: —Clinical Procedure: —Specialty: NeurologyObjective:Unusual clinical courseBackground:A rare variant of Guillain-Barré syndrome (GBS) consists of facial diplegia and paresthesia, but an even more rare association is with facial hemiplegia, similar to Bell’s palsy. This case report is of this rare variant of GBS that was associated with IgG antibodies to galactocerebroside and phosphatidic acid.Case Report:A 54-year-old man presented with lower left facial palsy and paresthesia of his extremities, following an upper respiratory tract infection. Physical examination confirmed lower left facial palsy and paresthesia of his extremities with hyporeflexia of his lower limbs and sensory loss of all four extremities. The differential diagnosis was between a variant of GBS and Bell’s palsy. Following initial treatment with glucocorticoids followed by intravenous immunoglobulin (IVIG), his sensory abnormalities resolved. Serum IgG antibodies to galactocerebroside and phosphatidic acid were positive in this patient, but not other antibodies to glycolipids or phospholipids were found. Five months following discharge from hospital, his left facial palsy had improved.Conclusions:A case of a rare variant of GBS is presented with facial diplegia and paresthesia and with unilateral facial palsy. This rare variant of GBS may which may mimic Bell’s palsy. In this case, IgG antibodies to galactocerebroside and phosphatidic acid were detected.

Guillain–Barré syndrome with unilateral peripheral facial and bulbar palsy in a child: A case report

“…Glucocorticoid therapy must be started early after onset of symptoms to shorten the time of recovery. [26][27][28][29] Facial palsy may resolve in 2 weeks with IVIG therapy. 10 The bulbar palsy implies the involvement of lower cranial nerves IX, X, XI, and XII.…”

Isolated facial diplegia: A rare presentation of Guillain‐Barre syndrome

“…There have been cases where IgG antibodies to galactocerebroside and phosphatidic acid are evident, indicating their possible use as a diagnostic marker. [7][8][9][10][11] However, in our case, these antibodies were not sent. NCV and EMG are helpful in establishing a diagnosis of GBS; 7,8 however, may often have nonspecific EMG findings in patients with facial diplegia.…”

A Case of Recurrent Facial Palsy Associated with Anti-GM2: is it anyway Guillain-barré syndrome?

“…Greco et al (2012) had postulated the hypothesis that Bellś palsy can be a mononeuritic variant of Guillain-Barré syndrome, a neurologic disorder with recognized cell-mediated immunity against peripheral nerve myelin antigens [6] . In fact, there are few cases in adults and children that debut with unilateral facial paralysis, which are ultimately ascertained as Guillain-Barre syndrome [7][8] . To reinforce this hypothesis, there is a temporal incidence correlation between Bell's palsy and Guillain-Barré syndrome at various times of the year [9] .…”