Acute inflammatory polyradiculoneuropathy of atypical presentation.

Abstract

Introduction: Guillain-Barré syndrome is an acute / subacute inflammatory polyradiculoneuropathy that classically results in flaccid areflex palsy. However, there are other possibilities of clinical presentation that must be remembered so that an adequate diagnosis and treatment is carried out. Case report: Female patient, 23 years old, without comorbidities, with complaint of paresthesia in extremities and right peripheral facial paralysis, having diagnosis until then of Bell’s Palsy. She denied previous or current infectious complaints. The neurological examination revealed facial diparesis, proximal weakness of the lower limbs that made walking difficult, tactile and painful hypoesthesia in the feet, with reflexes 1+/4+ in the lower limbs and 3+/4+ in the upper limbs. An investigation was started with CSF collection that showed albuminocytological dissociation (proteins 440 mg/dl and leukocytes 01 mm3). Neuroimaging exams showed contrast impregnation in facial and trigeminal nerves. A diagnosis of acute inflammatory polyradiculoneuropathy was made and treatment with human immunoglobulin was initiated for 5 days. Electroneuromyography showed peripheral, sensory-motor polyradiculoneuropathy and questioned the physiopathological possibility of juxtaparanodopathy. The patient presented a significant and early improvement after treatment. Conclusions: It is essential to consider that Guillain-Barré syndrome has symptom variability, especially according to its pathophysiology and clinical and electrophysiological variant, thus avoiding that conditions such as this one are underdiagnosed.