Guillain-Barré syndrome: Two Cases with Serious and Atypical Process

Background: Guillain-Barré syndrome is a weak paresis which may differ in many ways. It is a demyelizing affection after an acute infection. We show two serious processes with atypical progress as the affection of the proximal muscles was dominant.

Case 1 M.B. was born on January 26, 2017, and became ill on February 24, 3016. She saw double pictures, and on the next day she was not able to speak, walk, or swallow. She was brought into the hospital and lost her respiratory function, so she was intubated and she showed a complete weak paresis of the muscles. After immunoglobulin therapy, the patient started recovering slowly with weaning and detectable responses in EMG and NLGs. In rehabilitation, the mobilization began again slowly. At discharge of rehabilitation, she is able to move into standing position, grasp with both hands, and eat again. Now she can walk independently without any restrictions.

Case 2 J.B. was born on November 24, 2008, and became ill on August 11, 2016 with acute infection, high fever. After transient improvement, he presented neck stiffness and back pain. Because of suspected meningitis, antiviral and antibiotic therapy followed. After that he showed a respiratory exhaustion and intubation followed. Then paresis began in shoulder and neck; on the next day, there was complete lax paresis, suspicious of Guillain-Barre syndrome or parainfectious myelitis. Therefore, therapy with Urbason and immunoglobulin started with slow improvement and beginning of weaning from the respirator. Now he is able to walk, but we still see limitations in movement in shoulder and neck muscles and slight respiratory exhaustion. It is not possible to remove the tracheal cannula due to swallowing limitations.