Guillain-Barré Syndrome Emerging From Syringomyelia Management: A Case Report

The coexistence of Guillain-Barré syndrome with a spinal cord syrinx is extremely rare. This report presents the emergency admission of a 57-year-old female presenting with an abrupt and progressive loss of motor function and abnormal sensation in her lower extremities. MRI of the cervical spine revealed a syrinx extending from C2 to C7. Neurology referred the case to neurosurgery, who assessed the patient and recommended nonoperative and supportive treatment given the size of the syrinx and the patient's status as a poor surgical candidate. She was subsequently discharged to a local extended care facility (ECF) with a diagnosis of syringomyelia. Despite physical therapy and rehabilitation, her symptoms progressed to include loss of motor function in bilateral lower extremities, worsening paresthesia in bilateral upper and lower extremities, and progressive dyspnea. Nerve conduction studies performed during neurologic evaluation at the ECF demonstrated a sensorimotor demyelinating polyneuropathy, and she was urgently transferred to the emergency department, where Guillain-Barré syndrome was confirmed. The patient developed respiratory failure requiring mechanical ventilation and was treated with intravenous immunoglobulin. Although she experienced transient stabilization, her clinical course was complicated by progressive functional decline. This case highlights how a cervical syrinx may obscure the initial presentation of Guillain-Barré syndrome, contributing to delayed treatment, and demonstrates the importance of maintaining a broad differential diagnosis in patients with atypical or overlapping neurologic findings.