Unmasking Ataxic Guillain–Barre Syndrome: A Rare Presentation

Abstract

A 68-year-old right-handed male with a history of hypertension presented with unsteadiness while walking for 5 days preceded by a vague pain in the left shoulder and both thighs and paresthesias in all extremities. It rapidly progressed to severe gait ataxia, bilateral facial palsy, and speech difficulties. On examination, he had bilateral lower motor neuron type of facial palsy, a wide-based stance, gait ataxia, left-sided hypotonia, cerebellar signs, and generalized areflexia. He had left-sided hypotonia and normal power of all four limbs. Sensory system examination was normal, and Rhomberg’s sign was negative. He had no ophthalmoplegia. While initial considerations pointed toward a cerebrovascular accident, normal magnetic resonance imaging results prompted us to do a lumbar puncture and cerebrospinal fluid analysis, which revealed albuminocytological dissociation indicative of Guillain–Barré Syndrome (GBS). Nerve conduction studies then confirmed our diagnosis. Given these results and a preceding respiratory infection, the patient was diagnosed with a rare ataxic variant of GBS. The patient was treated with plasmapheresis following which he showed dramatic clinical improvement. He was subsequently able to walk without support and perform the majority of his day-to-day activities on his own. He was discharged in a hemodynamically stable condition. This case report, thus, highlights a rare ataxic variant of GBS presenting with acute onset ataxia, areflexia, and facial diplegia. Thus, understanding the GBS and its variants is crucial to managing rare presentations swiftly and avoiding severe complications. It has tremendous scope for further research to understand the pathophysiological dynamics completely and find more targeted therapeutic approaches. We, thus, present a rare case of an ataxic variant of GBS with acute onset ataxia, areflexia, and facial diplegia.