Twelfth cranial nerve involvement in Guillian Barre syndrome

Area of Science:

• Neurology
• Neuroimmunology
• Clinical Case Studies

Background:

• Guillian Barre Syndrome (GBS) is an autoimmune disorder affecting the peripheral nervous system.
• Cranial nerve involvement is a known complication of GBS, most commonly affecting the facial (VII), glossopharyngeal (IX), and vagus (X) nerves.
• Isolated or significant twelfth cranial nerve (XII) involvement is infrequently reported in GBS literature.

Observation:

• A 13-year-old male presented with symptoms consistent with GBS.
• Two weeks post-onset, the patient developed severe weakness and muscle wasting of the tongue, indicative of XIIth nerve dysfunction.
• No other cranial nerve palsies were noted.

Findings:

• The patient's GBS diagnosis was confirmed through standard clinical and electrodiagnostic criteria.
• The observed tongue weakness and wasting were attributed to XIIth cranial nerve involvement secondary to GBS.
• Significant improvement in tongue strength and muscle bulk was noted at the three-month follow-up.

Implications:

• This case highlights the potential, albeit rare, for significant XIIth cranial nerve involvement in pediatric GBS.
• It underscores the importance of a comprehensive neurological examination in GBS patients to detect less common cranial nerve deficits.
• Further investigation into the mechanisms and prognosis of XIIth nerve involvement in GBS may be warranted.