Guillain-Barré syndrome with bilateral extensor plantar responses: A rare case report

Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy, typically presenting with rapidly progressive symmetrical limb weakness and areflexia. However, upper motor neuron signs, such as extensor plantar responses, are occasionally reported, suggesting overlapping central nervous system features and presenting diagnostic challenges. We report a rare case of GBS with cranial nerve onset, bilateral facial diplegia, ascending limb weakness, and bilateral extensor plantar responses. A 34-year-old woman presented with an acute onset of bilateral facial weakness followed by progressive limb weakness and distal paresthesia after a brief febrile illness. Neurological examination revealed lower motor neuron bilateral facial palsy, proximal limb weakness, impaired joint position sensation, and bilateral extensor plantar response. Deep tendon reflexes were diminished in the lower limbs and brisk in the upper limbs. Magnetic resonance imaging of the brain and spine was normal. Cerebrospinal fluid analysis demonstrated albuminocytological dissociation. Nerve conduction studies showed features of demyelinating polyneuropathy. The patient initially worsened following corticosteroid therapy but showed significant improvement after treatment with intravenous immunoglobulin. At follow-up, she achieved near complete recovery with minimal residual facial weakness. This report highlights the diagnostic and therapeutic challenges of atypical GBS variants and emphasizes the importance of early recognition and appropriate management.