An unusual case of recurrent Guillain-Barré syndrome with normal cerebrospinal fluid protein levels: a case report

Abstract

BackgroundGuillain-Barré syndrome is an acquired polyradiculo-neuropathy, often preceded by an antecedent event. It is a monophasic disease but a recurrence rate of 1–6 % is documented in a subset group of patients. Patients with Guillain-Barré syndrome show cerebrospinal fluid albuminocytologic dissociation. Normal cerebrospinal fluid protein levels during both initial and recurrent episodes of Guillain-Barré syndrome is a rare occurrence and has not been described earlier in the literature.Case presentationTwenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months’ time respectively, rather a faster recovery than usually expected.ConclusionRecurrence of Guillain-Barré syndrome can occur in a subset of patients with Guillain-Barré syndrome even after many years of asymptomatic period. Normal cerebrospinal fluid profile does not exclude Guillain-Barré syndrome and may occur in subsequent recurrences of Guillain-Barré syndrome arising the need for further studies to identify the pathophysiology and the possibility of a different subtype of Guillain-Barré syndrome.

Guillain-barre syndrome as a presenting manifestation of gallbladder carcinoma; paraneoplastic or coincidence

“…GBS is a medical emergency, which usually presents with acute onset, rapidly progressive, ascending paralysis [5]. Our patient presented with 2 weeks duration of symptoms.…”

“…Generally, cyto-albumin dissociation can be seen in 82-90 % of patients with GBS 10-14 days from the onset of the illness. But a normal CSF profile is found in 10% of GBS patients throughout the disease [5].…”

Intravenous immunoglobulin in COVID-19 associated Guillain–Barré syndrome in pregnancy

“…Review of available literature has not revealed potential mechanisms or differentials for this phenomenon. 6 7 …”

An incomplete form of anti-ganglioside antibody-positive Miller Fisher syndrome after an Epstein-Barr virus infection

“…Although albuminocytologic dissociation is seen in 82% to 90% of patients with GBS by the end of the second week of illness, normal protein levels may still be present during the first week. [ 6 ] CSF albuminocytological dissociation is absent within the first week of symptom onset in more than half of the patients with GBS. Nerve conduction studies and CSF analyses are often inconclusive in the early stages of the disease, [ 7 ] and CSF can show a normal protein level in weak patients early in presentation.…”