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Descending Weakness: Dysphagia with Bilateral Upper Extremity Weakness

Guillain-Barré syndrome (GBS) is described classically as presenting with ascending paralysis. This can be misleading as there are several different phenotypes...

The pharyngeal-cervical-brachial (PCB) variant of GBS is characterized by bifacial weakness, dysphagia, and bilateral upper extremity paralysis and is typically a pure motor syndrome. This syndrome can mimic other more common disorders, such as stroke, leading to a delay in diagnosis. Increasing awareness of this atypical variant of GBS can improve earlier recognition by providers, which can lead to improved outcomes.

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Articles of Interest

Atypical Descending Paralysis in Miller Fisher Syndrome: A Rare Variant of Guillain-Barre Syndrome

Patients presenting with acute descending symmetrical paralysis and symptoms such as ophthalmoplegia, ataxia, and upper limb involvement can be considered to be suffering from MFS which is a rare variant of GBS. This suspicion should be diagnosed properly with CSF analysis, nerve conduction studies, and specific antiganglioside GQ1b antibodies. After the diagnosis, plasmapheresis and IVIG are the two options to treat this condition. Symptoms improve gradually in 2-4 weeks and relapses are rare.

Atypical Guillain-Barré in the Emergency Department

Guillain Barré Syndrome (GBS), although an uncommon diagnosis in the emergency department (ED), usually presents as one of the more common chief complaints—weakness. In this report we present an unusual case of weakness, initially seen in the ED and sent home only to return with worsening symptoms and ultimately found to be GBS.

Atypical Presentation of Guillain-Barré Syndrome (GBS) with Facial Diplegia and Retained Reflexes associated with COVID-19 Infection

This case demonstrates that GBS associated with COVID-19 infection can present with isolated facial diplegia, and significant benefit can be achieved with a short course of IVIG administered at home during a pandemic.

Descending GBS - An Atypical Presentation

Day 5 of admission the patient developed bulbar symptoms; a repeat LP was done where albuminocytogical dissociation was noted. Higher mental function normal, bilateral facial nerve palsy, facial diplegia with decrease palatal movement, an absent gag reflex.

Descending paralysis as an atypical presentation of Guillain–Barré Syndrome

Guillain–Barré syndrome (GBS) is an acute immune-mediated polyneuropathies, which has various clinical presentations. The original description of “ascending paralysis” includes the most common variants.1 However, there are a number of uncommon variants of GBS. We present one unusual case of inflammatory demyelinating polyneuropathy with ascending upper extremity and descending lower extremity paralysis without bulbar or sensory involvement.

Guillain-Barré Syndrome (GBS): Typical and Atypical Clinical Presentations

Therefore, to make the correct diagnosis and initiate appropriate treatment in time, it is important to know the presentation of typical GBS as well as the features of atypical but clinically distinct variants and subtypes

Variants of Guillain-Barre Syndrome

The pharyngeal-cervical-brachial variant is distinguished by isolated facial, oropharyngeal, cervical, and upper limb weakness without lower limb involvement. Other unusual clinical variants with restricted patterns of weakness are observed only in rare cases.