“Wake-up” onset of pharyngocervicobrachial variant of Guillain-Barré syndrome: a case report

Abstract

Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis in the world. There are variants. Of the cranial forms, the following stand out: the classic form, facial diplegia with distal paresthesias, pharyngo-cervico-brachial form, polyneuritis cranialis, Miller-Fisher syndrome and Bickerstaff encephalitis. This study aimed to report the case of a 73-year-old male patient, diabetic, former smoker and alcoholic, who presented at the Neurology outpatient clinic of a tertiary hospital in Pernambuco, after emergency care and 19 days of symptoms, reported as sudden cervical weakness, dysarthrophonia, dysphagia and weakness in the right hemiface, three weeks after vaccination (influenza and triple viral) and flu syndrome. He had dyspnea since the onset of the condition, with no progression or fluctuating complaints. The neurological examination showed multiple cranial nerve syndrome (right peripheral pattern facial palsy, reduced elevation of the soft palate and cervical extension paresis) associated with global hypo/arreflexia. Complementary exams showed, in addition to leukocytosis and signs of bronchopathy on chest tomography, cerebrospinal fluid with 00 cells and 48 proteins and electroneuromyography with predominantly sensitive axonal polyneuropathy, decrease in bilateral facial motor amplitude, needle with myopathic pattern. Brain magnetic resonance imaging without alterations. With the possibility of cranial polyradiculoneuritis and a history of dyspnea raised, he was admitted to the intensive care unit to monitor his breathing pattern and dysautonomia. He received antibiotic therapy for seven days due to pneumonia and pulse therapy with IVIG (2 g/kg for five days). He maintained progressive improvement of symptoms. He was discharged with a multidisciplinary outpatient follow-up scheduled. It is concluded, therefore, that the recognition of GBS and variant forms is necessary.