Atypical presentation of Guillain Barré Syndrome in pediatrics. Case report

Abstract

Atypical variants of Guillain Barré Syndrome (GBS) include asymmetric weakness and sensory symptoms, predominantly distal or proximal, diffuse pain or isolated involvement of cranial nerves prior to the onset of symptoms, irritability, meningismus and unsteady gait. Objective: to describe the following case of GBS with atypical presentation in a pediatric patient due to asymmetric weakness, gait disturbance, and unilateral involvement of the XII cranial nerve. Clinical Case: Afro-Colombian male adolescent, with left hemiparesis of distal onset, gait disturbance, ataxia, difficulty in lifting and left lateralization of the tongue. The diagnosis was supported by the study of cerebrospinal fluid with cytological albumin dissociation, magnetic resonance imaging showed enhancement of nerve roots and neuroconduction studies compatible with axonal-type polyneuropathy in the lower limbs. Conclusions: atypical presentations of GBS constitute a diagnostic challenge, the asymmetric weakness, and the compromise of the XII cranial nerve make it necessary to rule out other pathologies. Clinical history and physical examination supported by complementary studies of cerebrospinal fluid, neuroimaging and neuroconduction are useful to confirm GBS. Knowledge of the atypical variables of GBS in the pediatric population is essential for timely identification and early treatment.