AAEE case report #4: Guillain-Barré syndrome

A case report is presented of a 33-year-old woman who awoke with distal paresthesias, mild incoordination, and progressive weakness. Examination 3 days later demonstrated weakness of the extremities, which was greater in distal muscles than in proximal ones, mild facial weakness, distal vibratory loss, and areflexia. Electrodiagnostic studies provided evidence of an acquired demyelinating polyradiculoneuropathy of recent onset. Motor conduction studies revealed abnormal temporal dispersion and partial conduction block. Preserved sural responses with abnormal median sensory conduction studies supported the diagnosis of Guillain-Barré syndrome, as did subsequent cerebrospinal fluid examinations documenting increasing total protein, identification of preceding cytomegalovirus injection with increasing serum convalescent titer, and progressive clinical improvement after a brief plateau. The role of electrodiagnosis in establishing the diagnosis and prognosis in Guillain-Barré syndrome is reviewed.