Recurrent Guillain-Barré Syndrome Following Ischemic Stroke: A Rare Case With a Four-Year Inter-Episode Interval

Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy that typically follows infections and is usually monophasic, with recurrence occurring in only a few cases. Its development after cerebrovascular events is exceedingly rare, complicating timely recognition due to overlapping neurological deficits. We describe a 67-year-old man who, four years earlier, experienced an acute right basal ganglia ischemic stroke and, on the fourth day of hospitalization, developed rapidly progressive quadriparesis and areflexia. Initial suspicion for stroke recurrence or hemorrhagic transformation was excluded by neuroimaging. Cerebrospinal fluid analysis revealed albuminocytologic dissociation, and nerve conduction studies demonstrated acute motor-sensory axonal neuropathy (AMSAN), confirming GBS. He was treated with intravenous immunoglobulin, achieving a gradual recovery. Four years later, he presented with spontaneous ascending weakness and respiratory compromise. Cerebrospinal fluid protein was elevated, and repeat nerve conduction studies showed acute inflammatory demyelinating polyneuropathy (AIDP). Plasmapheresis, supportive care, and structured rehabilitation resulted in substantial neurological improvement. This case highlights the rare occurrence of GBS following stroke and the potential for recurrence years later, even without identifiable triggers. It underscores the need for high clinical suspicion in post-stroke patients with new neuromuscular deficits, the utility of serial electrophysiological evaluation for subtype classification, and the importance of timely immunotherapy and vigilant supportive care. Recognition of such atypical presentations is essential to reduce morbidity, prevent respiratory failure, and guide long-term follow-up for recurrent episodes.