[A case of Guillain-Barrè syndrome with severe sciatica preceding motor paralysis in the lower extremities]

A 62-year-old man was referred to our clinic for a three-day history of intractable sciatic pain. The pain was so severe that he could not sleep for days. Initially there was no neuronal sign except for the pain, nor any abnormality in lumbar CT and MRI. Cerebrospinal fluid sampled on the third hospital day revealed elevated protein (192 mg.dl-1) with minimal cells. On the 4th hospital day motor weakness of lower extremities appeared and he developed complete flaccid paraplegia in a week without loss of sensation. He was diagnosed as Guillain-Barrè syndrome. For the relief of this pain, intermittent injection of 4 ml 0.25% bupivacaine from lumbar epidural catheter was started on the admission day. By using patient controlled analgesia system, we could treat his repetitive demand timely and well control the pain. The leg weakness started to recover slowly from the 13th hospital day and at the same time the pain started to diminish rapidly in a few days. From the 20th hospital day he started to have rehabilitation in walking and recovered completely in two months without complication. We should remember that sudden onset of severe pain is one of early symptoms of Guillain-Barrè syndrome.