Guillain-Barré syndrome with overlap between the finger drop variant and acute bulbar palsy: a case report.
Anti-ganglioside antibody
Bulbar palsy
Finger drop sign
Guillain-Barré syndrome
Journal
BMC neurology
ISSN: 1471-2377
Titre abrégé: BMC Neurol
Pays: England
ID NLM: 100968555
Informations de publication
Date de publication:
23 Oct 2024
23 Oct 2024
Historique:
received:
03
04
2024
accepted:
03
10
2024
medline:
24
10
2024
pubmed:
24
10
2024
entrez:
24
10
2024
Statut:
epublish
Résumé
Guillain-Barré syndrome (GBS) is a clinically heterogenous disease and encompasses several distinct clinical variants. Overlap between these variants can pose a diagnostic challenge. We report a case of finger drop variant and acute bulbar palsy overlap as an unusual manifestation of GBS. An 81-year-old man presented with dysarthria, dysphagia, and upper limb weakness. Neurological examination revealed impaired tongue protrusion, the finger drop sign, and diminished brachioradial and triceps muscle reflexes. Nerve conduction studies showed reduced amplitudes and decreased velocities in the median and ulnar nerves. Cerebrospinal fluid analysis revealed albuminocytological dissociation and an anti-ganglioside antibody study revealed positivity for GM1, asialo-GM1, GT1a, GD1b, and GQ1b. As GBS was suspected, we initiated intravenous immunoglobulin treatment, resulting in gradual improvement within the next 3 weeks. To the best of our knowledge, this is the first reported case of an overlap between the finger drop variant and acute bulbar palsy in GBS, highlighting the importance of considering GBS when patients present with a combination of atypical symptoms. Anti-ganglioside antibodies can be helpful and add diagnostic value in these complex cases.
Sections du résumé
BACKGROUND
BACKGROUND
Guillain-Barré syndrome (GBS) is a clinically heterogenous disease and encompasses several distinct clinical variants. Overlap between these variants can pose a diagnostic challenge. We report a case of finger drop variant and acute bulbar palsy overlap as an unusual manifestation of GBS.
CASE PRESENTATION
METHODS
An 81-year-old man presented with dysarthria, dysphagia, and upper limb weakness. Neurological examination revealed impaired tongue protrusion, the finger drop sign, and diminished brachioradial and triceps muscle reflexes. Nerve conduction studies showed reduced amplitudes and decreased velocities in the median and ulnar nerves. Cerebrospinal fluid analysis revealed albuminocytological dissociation and an anti-ganglioside antibody study revealed positivity for GM1, asialo-GM1, GT1a, GD1b, and GQ1b. As GBS was suspected, we initiated intravenous immunoglobulin treatment, resulting in gradual improvement within the next 3 weeks.
CONCLUSION
CONCLUSIONS
To the best of our knowledge, this is the first reported case of an overlap between the finger drop variant and acute bulbar palsy in GBS, highlighting the importance of considering GBS when patients present with a combination of atypical symptoms. Anti-ganglioside antibodies can be helpful and add diagnostic value in these complex cases.
Identifiants
pubmed: 39443861
doi: 10.1186/s12883-024-03899-3
pii: 10.1186/s12883-024-03899-3
doi:
Substances chimiques
Immunoglobulins, Intravenous
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
411Informations de copyright
© 2024. The Author(s).
Références
the GBS Classification Group, Wakerley BR, Uncini A, Yuki N. Guillain–Barré and Miller Fisher syndromes—new diagnostic classification. Nat Rev Neurol. 2014;10(9):537–44.
doi: 10.1038/nrneurol.2014.138
Yoon B, Ha D, Park HT, Kusunoki S, Kuwahara M, Lee JH, et al. Finger drop sign as a new variant of acute motor axonal neuropathy. Muscle Nerve. 2021;63(3):336–43.
doi: 10.1002/mus.27126
pubmed: 33217007
Wakerley BR, Yuki N. Pharyngeal-cervical-brachial variant of Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry. 2014;85(3):339–44.
doi: 10.1136/jnnp-2013-305397
pubmed: 23804237
Koga M. Anti-GT1a IgG in Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry. 2002;72(6):767–71.
doi: 10.1136/jnnp.72.6.767
pubmed: 12023422
pmcid: 1737908
Walgaard C, Lingsma HF, Ruts L, Drenthen J, Van Koningsveld R, Garssen MJP, et al. Prediction of respiratory insufficiency in Guillain-Barré syndrome. Ann Neurol. 2010;67(6):781–7.
doi: 10.1002/ana.21976
pubmed: 20517939
Utanohara Y, Hayashi R, Yoshikawa M, Yoshida M, Tsuga K, Akagawa Y. Standard values of Maximum Tongue pressure taken using newly developed Disposable Tongue pressure measurement device. Dysphagia. 2008;23(3):286–90.
doi: 10.1007/s00455-007-9142-z
pubmed: 18574632
Ho TW, Mishu B, Li CY, Gao CY, Cornblath DR, Griffin JW, et al. Guillain-Barré syndrome in northern China Relationship to Campylobacter jejuni infection and anti-glycolipid antibodies. Brain. 1995;118(3):597–605.
doi: 10.1093/brain/118.3.597
pubmed: 7600081
Chan Y, Punzalan-Sotelo AM, Kannan TA, Shahrizaila N, Umapathi T, Goh EJH, et al. Electrodiagnosis of reversible conduction failure in Guillain–Barré syndrome. Muscle Nerve. 2017;56(5):919–24.
doi: 10.1002/mus.25577
pubmed: 28093784
Bae JS, Yuki N, Kuwabara S, Kim JK, Vucic S, Lin CS, et al. Guillain-Barre syndrome in Asia. J Neurol Neurosurg Psychiatry. 2014;85(8):907–13.
doi: 10.1136/jnnp-2013-306212
pubmed: 24357682
Kokubun N, Shahrizaila N, Hirata K, Yuki N. Reversible conduction failure is distinct from neurophysiological patterns of recovery in mild demyelinating Guillain–Barré syndrome. J Neurol Sci. 2013;326(1–2):111–4.
doi: 10.1016/j.jns.2013.01.015
pubmed: 23394975
Kim JK, Kim BJ, Shin HY, Shin KJ, Nam TS, Oh J, et al. Acute bulbar palsy as a variant of Guillain-Barré syndrome. Neurology. 2016;86(8):742–7.
doi: 10.1212/WNL.0000000000002256
pubmed: 26718574
Garg N, Yuki N, Park SB, Barnett MH, Kiernan MC. Acute bulbar, neck and limb weakness with monospecific anti-GT1a antibody: a rare localized subtype of Guillain‐Barré sydnrome. Muscle Nerve. 2016;53(1):143–6.
doi: 10.1002/mus.24935
pubmed: 26452439
Orlikowski D, Terzi N, Blumen M, Sharshar T, Raphael JC, Annane D, et al. Tongue weakness is associated with respiratory failure in patients with severe Guillain-Barré syndrome. Acta Neurol Scand. 2009;119(6):364–70.
doi: 10.1111/j.1600-0404.2008.01107.x
pubmed: 18976323
Yoshino H, Harukawa H, Asano A. IgG antiganglioside antibodies in Guillain–Barré syndrome with bulbar palsy. J Neuroimmunol. 2000;105(2):195–201.
doi: 10.1016/S0165-5728(99)00280-5
pubmed: 10742563
Susuki K, Yuki N, Hirata K. Fine specificity of anti-GQ1b IgG and clinical features. J Neurol Sci. 2001;185(1):5–9.
doi: 10.1016/S0022-510X(01)00464-6
pubmed: 11266684
Nagashima T, Koga M, Odaka M, Hirata K, Yuki N. Continuous spectrum of pharyngeal-cervical-brachial variant of Guillain-Barré Syndrome. Arch Neurol. 2007;64(10):1519.
doi: 10.1001/archneur.64.10.1519
pubmed: 17923636
Lardone RD, Yuki N, Odaka M, Daniotti JL, Irazoqui FJ, Nores GA. Anti-GM1 IgG antibodies in Guillain-Barre syndrome: fine specificity is associated with disease severity. J Neurol Neurosurg Psychiatry. 2010;81(6):629–33.
doi: 10.1136/jnnp.2009.183665
pubmed: 19965859
O’Leary CP, Veitch J, Durward WF, Thomas AM, Rees JH, Willison HJ. Acute oropharyngeal palsy is associated with antibodies to GQlb and GTla gangliosides. J Neurol Neurosurg Psychiatry 1996;61:649-651
Beydoun SR, Shatzmiller RA. Chronic immune-mediated demyelinating polyneuropathy in the setting of cetuximab treatment. Clin Neurol Neurosurg. 2010;112(10):900–2.
doi: 10.1016/j.clineuro.2010.07.005
pubmed: 20685033
Gogas HJ, Flaherty KT, Dummer R, Ascierto PA, Arance A, Mandala M, et al. Adverse events associated with encorafenib plus binimetinib in the COLUMBUS study: incidence, course and management. Eur J Cancer. 2019;119:97–106.
doi: 10.1016/j.ejca.2019.07.016
pubmed: 31437754