Asymmetric limb weakness in Guillain-Barré syndrome: Three case reports

Miller Fisher Syndrome as a Stroke Mimic: A Case Report

Guillain-Barre syndrome (GBS) is a heterogeneous autoimmune disorder characterized by peripheral neuropathy, often triggered by preceding infections or vaccinations. It encompasses several clinical variants, including the rare Miller Fisher Syndrome (MFS), distinguished by ophthalmoplegia, ataxia, and areflexia. Diagnosis is challenging due to varied presentations and potential overlap with other neurological conditions. We present a case of a 42-year-old male initially suspected to have a stroke when he presented with unilateral loss of sensation and dysarthria. He was later diagnosed with MFS after his condition progressed and he developed generalized weakness, ophthalmoplegia, ataxia, and areflexia. Despite initial stability, his condition deteriorated, requiring intensive care. Early recognition and treatment, such as intravenous immunoglobulin (IVIg) and plasmapheresis, are critical for improving outcomes in GBS and its variants. This case underscores the importance of clinical suspicion and appropriate diagnostic strategies in managing these complex neurological disorders.

Electrodiagnostic methods to verify Guillain-Barré syndrome subtypes in Istanbul: A prospective multicenter study

BACKGROUND AND AIMS

This study aimed to identify the clinical characteristics and electrodiagnostic subtypes of Guillain-Barré syndrome (GBS) in Istanbul.

METHODS

Patients with GBS were prospectively recruited between April 2019 and March 2022 and two electrodiagnostic examinations were performed on each patient. The criteria of Ho et al., Hadden et al., Rajabally et al., and Uncini et al. were compared for the differentiation of demyelinating and axonal subtypes, and their relations with anti-ganglioside antibodies were analyzed.

RESULTS

One hundred seventy-seven patients were included, 69 before the coronavirus disease 2019 pandemic (April 2019-February 2020) and 108 during the pandemic (March 2020-March 2022), without substantial changes in monthly frequencies. As compared with the criteria of Uncini et al., demyelinating GBS subtype diagnosis was more frequent according to the Ho et al. and Hadden et al. criteria (95/162, 58.6% vs. 110/174, 63.2% and 121/174, 69.5%, respectively), and less frequent according to Rajabally et al.'s criteria (76/174, 43.7%). Fourteen patients' diagnoses made using Rajabally et al.'s criteria were shifted to the other subtype with the second electrodiagnostic examination. Of the 106 analyzed patients, 22 had immunoglobulin G anti-ganglioside antibodies (14 with the axonal subtype). They had less frequent sensory symptoms (54.5% vs. 83.1%, p = 0.009), a more frequent history of previous gastroenteritis (54.5% vs. 22.9%, p = 0.007), and a more severe disease as compared with those without antibodies.

INTERPRETATION

Serial electrodiagnostic examinations are more helpful for accurate subtype diagnosis of GBS because of the dynamic pathophysiology of the disease. We observed no significant increase in GBS frequency during the pandemic in this metropolis.