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Asymmetric Guillain-Barré Syndrome as a Stroke Mimic
Guorong Zhang1, Yuzhong Wang1,2, Nobuhiro Yuki3
1Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China.
Journal of the Peripheral Nervous System : JPNS
|July 14, 2026
Summary
Asymmetric Guillain-Barré syndrome (GBS) can mimic stroke, leading to delayed diagnosis and treatment. Recognizing specific features like lack of facial weakness and axonal subtype aids early identification for prompt immunotherapy.
Area of Science:
- Neurology
- Neuroimmunology
Background:
- Guillain-Barré syndrome (GBS) typically presents with symmetric weakness.
- Marked asymmetry in GBS can mimic stroke, delaying diagnosis.
- Unilateral onset progressing to bilateral asymmetric involvement presents a diagnostic challenge.
Purpose of the Study:
- Characterize the phenotype of asymmetric GBS.
- Identify features that facilitate early recognition of asymmetric GBS.
- Compare diagnostic timelines and clinical features between asymmetric and symmetric GBS cases.
Main Methods:
- Retrospective analysis of 611 GBS patients over 10 years.
- Asymmetry defined as ≥2-point difference on the MRC scale between contralateral limbs.
- Comparison of clinical features, electrophysiological subtypes, and diagnostic timelines.
Main Results:
- 5.2% of patients (32) had asymmetric GBS.
- Asymmetric GBS cases had fewer antecedent respiratory infections and no facial weakness.
- Asymmetric GBS was associated with longer diagnostic delays, delayed immunotherapy, and greater disability.
Conclusions:
- Unilateral-onset GBS evolving into bilateral asymmetry is most likely to mimic stroke.
- Absence of facial weakness, few antecedent infections, axonal subtype, and anti-ganglioside antibodies aid recognition.
- Timely immunotherapy is crucial for patients with asymmetric GBS.
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