Atypical forms of Guillain Barré syndrome

Guillain Barreé syndrome (GBS) is well defined clinical entity characterized by primary demyelinating lesions of the peripheral nerves and spinal roots. The main signs are: symmetrical ascendant muscular weakness, loss of tendon reflexes, symmetrical sensory loss and autonomic dysfunctions. Neurophysiological tests commonly demonstrate impaired condition of the peripheral nerves. Many variants of GBS are recognized by clinical findings including involvement of motor and sensory nerves and autonomic nervous system. The diagnosis is easy in typical forms but recognition of atypical forms makes the monitoring of disease complications possible and identifies therapeutic options for affected children. We intend to present a case of a pharyngeal-cervicalbrachial form of GBS ( first reported in 1986. ) A 15-year old male developed swallowing difficulties, nasal speech, weakness of bulbar musculature, soft palate and facial muscles paresis, asymmetric weakness of cervical and brachial muscles. The laboratory and neurophysiological tests will be presented as well as videos of the affected patient. Immunomodulatory treatment with i.v. immunoglobulins began and physical therapy was performed. Recovery of muscle weakness begun but the facial muscles recovered more slowly. The differential diagnosis of GBS are presented and the difficulties in diagnosis of GBS in childhood are discussed.

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