Weakness in both lower limbs for 1 week and blepharoptosis for 3 days in a boy aged 1 year and 7 months

Area of Science:

• Pediatric Neurology
• Neuroimmunology
• Clinical Neuroscience

Background:

• Guillain-Barré syndrome (GBS) and its overlap syndromes present significant diagnostic challenges in children.
• Anti-GD1b antibody-related GBS overlap syndromes exhibit unique clinical and neurophysiological features.
• Clinical heterogeneity in pediatric GBS overlaps stems from combined peripheral nerve and brainstem involvement.

Purpose of the Study:

• To report a pediatric case of GBS overlapping with Miller-Fisher syndrome and Bickerstaff brainstem encephalitis.
• To highlight the diagnostic difficulties and clinical manifestations of anti-GD1b antibody-related GBS overlap syndromes.
• To emphasize the importance of specific neurophysiological tests in diagnosing pediatric GBS variants.

Main Methods:

• Case presentation of a 1-year-7-month-old boy with progressive neurological deficits.
• Neurological examination including muscle strength assessment and reflex evaluation.
• Cerebrospinal fluid analysis, H reflex testing, and serum anti-GD1b IgG antibody testing.

Main Results:

• The patient exhibited lethargy, blepharoptosis, limb weakness (upper limbs grade 4, lower limbs grade 3), and absent reflexes.
• Laboratory findings included albuminocytological dissociation, absent H reflex, and positive anti-GD1b IgG.
• Diagnosis of Guillain-Barré syndrome overlapping with Miller-Fisher syndrome and Bickerstaff brainstem encephalitis was confirmed.

Conclusions:

• Anti-GD1b antibody-related GBS overlap syndromes in children are clinically heterogeneous and neurophysiologically complex.
• Nerve conduction velocity tests, particularly the H reflex, are essential for diagnosing pediatric GBS variants with limb weakness and ptosis.
• Prompt diagnosis and treatment, including immunoglobulin and plasma exchange, led to the patient's recovery.