Pharyngeal-Cervical-Brachial Variant of Guillain-Barre Syndrome

Abstract

Guillain-Barre syndrome (GBS) is the most common cause of acute neuromuscular paralysis in the Western world. We describe the only known case presentation of pharyngeal-cervical-brachial variant following a subacute myocardial infarction and Vibrio cholerae vaccination. A 55-year-old Filipino man presented to our emergency department with a one-day history of progressive oropharyngeal and cervicobrachial weakness and areflexia in the upper limbs. His review of systems was unremarkable except for receiving "Dukoral" traveller's diarrhea vaccine 3 weeks prior. His physical exam was compatible with GBS. EMG and nerve conduction studies showed low motor amplitudes, prolonged distal latency and absent F-waves in the arms. Lumbar puncture showed a protein level of 579 mg/L. Nuclear perfusion scan was consistent with a subacute myocardial infarction. He received a 2-day course of intravenous immunoglobulin. He showed significant improvement in his weakness over 3 days. Recent vaccination and myocardial infarction may be important triggers for GBS onset.

Guillain-Barré Syndrome: Inverted Paralysis Post-Operatively in a Patient With Ulcerative Colitis

“…Deep-tendon reflexes are absent in 90% of patients as well [ 3 ] . As the PCB variant is quite rare, it can often be misdiagnosed as a brain stem stroke, myasthenia gravis, or botulism [ 4 ]. The relationship of this variant to underlying autoimmune diseases and the stress of surgery is not only uncommon, but widely underreported.…”

Post-Vaccination Pharyngeal-Cervical-Brachial Variant of Guillain-Barré Syndrome

“…But rarer still is the association with vaccination. Hall et al reported a case of PCB in a middle-aged man who had Vibrio cholerae vaccination but reports of post-vaccination PCB variant of GBS are scarce globally [1]. We are not aware of similar cases in sub-Saharan Africa.…”

“…Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyradiculopathy that is characterized by an acute-onset symmetrical flaccid muscle weakness with decreased or absent deep tendon reflexes. Pharyngeal-cervical-brachial (PCB) variant of GBS is a localized variant that presents with facial palsy, dysarthria, or dysphagia in addition to the weakness of the upper extremity and areflexia of the upper limbs [1]. These features should not occur in the settings of ophthalmoplegia, ataxia, altered consciousness, and prominent lower limb weakness.…”