Nguyen Quang, Janku Cynthia, Tan Michelle, Hunsucker Rachel, Li Jeffrey J, Salahuddin Tehmina
Neurology, California University of Science and Medicine, Colton, USA.
Arrowhead Neurosurgical Medical Group, Redlands Community Hospital, Redlands, USA.
Cureus. 2023 Dec 8;15(12):e50184. doi: 10.7759/cureus.50184. eCollection 2023 Dec.
Guillain-Barré syndrome (GBS) is a rare entity with characteristic features, including progressive ascending paralysis. Patients typically present with progressive symmetrical weakness with areflexia in bilateral lower extremities, which can be confounded by psychiatric comorbidities. This case is unusual in that the patient had paradoxical hyperreflexia and normal CSF protein levels during her initial presentation, later confirmed to be GBS.
Here, we describe the case of a young female with bipolar disorder who presented to the hospital with complaints of week-long bilateral lower leg weakness that started abruptly about a month after an episode of multiple stools of bloody diarrhea. The initial neurological exam revealed 4/5 bilateral lower extremity strength and near global areflexia, excluding a 3+ right patellar reflex, and CSF studies returned normal CSF protein levels. Based on the clinical presentation of worsening ascending paralysis, electromyography (EMG) findings, and nerve conduction studies (NCS) consistent with an axonal and demyelinating neuropathy, we diagnosed her with the classic form of Guillain-Barré syndrome with paradoxical hyperreflexia. Imaging results, laboratory findings, treatment decisions, and outcomes of this case are presented.
吉兰 - 巴雷综合征（GBS）是一种具有特征性表现的罕见疾病，包括进行性上升性麻痹。患者通常表现为双侧下肢进行性对称性无力伴腱反射消失，这可能会因合并精神疾病而变得复杂。该病例不同寻常之处在于，患者在初次就诊时出现了矛盾性反射亢进且脑脊液蛋白水平正常，后来确诊为吉兰 - 巴雷综合征。
在此，我们描述一名患有双相情感障碍的年轻女性病例，她因双侧小腿无力长达一周而入院，这种无力在一次血性腹泻多次发作约一个月后突然开始。初次神经系统检查显示双侧下肢肌力为4/５，几乎全身性腱反射消失，但右侧髌反射为3+，脑脊液检查显示脑脊液蛋白水平正常。基于进行性上升性麻痹的临床表现、肌电图（EMG）结果以及与轴索性和脱髓鞘性神经病变一致的神经传导研究（NCS），我们将她诊断为伴有矛盾性反射亢进的经典型吉兰 - 巴雷综合征。本文展示了该病例的影像学结果、实验室检查结果、治疗决策及治疗结果。
