A 57-year-old Caucasian gentleman presented with bilateral progressive distal upper limb paraesthesiae, which he described as a feeling of “heaviness” followed by distal lower limb and mild tongue parasthaesia. He complained of dysaesthetic symptoms in his upper limbs with intermittent burning and tingling and autonomic disturbances such as excessive sweating of the face, hands and legs. He later developed epigastric pain that radiated to the chest, which was not related to exercise. According to the patient, symptoms got worse after taking the influenza vaccine. On examination, he had gait disturbance with weaker left lower limb muscles. During his stay in hospital, he also developed slight dysarthria and diplopia, together with urinary retention and constipation. He had had a similar, though much less severe, episode six years previously where he was diagnosed with Guillain-Barré Syndrome based on his clinical features, EMG result and his high protein levels in the CSF (more than 8g/L). He was treated with IVIG and recovered completely. This was his second presentation of neuromuscular weakness and he was referred for immunoglobulin treatment and intensive physiotherapy.
GBS is an acute inflammatory immune-mediated disorder affecting the peripheral nervous system. GBS typically manifests as sudden distal symmetrical parasthaesia that ascends to the upper limbs and progresses to weakness. A few patients undergo sensory dysfunction especially in the demyelinating forms of GBS. About a third of hospitalised patients are mechanically ventilated due to diaphragmatic, respiratory and oropharyngeal muscle weaknesspeer-reviewe
