Radial nerve palsy in Guillain-Barré syndrome

The risk of focal compression neuropathy in the setting of an underlying inflammatory polyneuropathy is unknown. A man developed ascending weakness and severe sensory ataxia and could not walk. Electromyography was diagnostic of Guillain-Barré syndrome. He improved with gammaglobulin and was released home 1 month later. Shortly after discharge, he developed severe left arm pain followed by wrist and finger drop. He was readmitted for another round of gamma-globulin without improvement. Subsequent electromyography showed severe radial neuropathy. Only then did he disclose that he usually slept with his wife's head on his arm at home. Two years later, he had recovered from Guillain-Barré syndrome with minimal gait imbalance, but wrist and finger extension remained weak. Reduced awareness of warning paresthesias coupled with the underlying polyneuropathy may account for this case of severe radial nerve compression. Potential mechanisms underlying increased nerve susceptibility to compression in the setting of polyneuropathy are reviewed.