Unusual Guillain-Barre syndrome with normal myotatic reflexes

*Correspondence: [e-mail].

Abstract

Case Presentation: A 6-year-old boy, 3 weeks after a self-limited case of gastroenteritis, developed distal upper limbs weakness followed by low back pain and lower limbs weakness, with inability to walk. At the initial evaluation, he presented mild proximal and distal upper limbs paresis and proximal lower limbs paresis. Myotatic reflexes were globally brisk. Laségue and Kernig signs were positive. Sensory and autonomic disturbances or cranial nerve changes were absent. Magnetic resonance imaging (MRI) demonstrated enhancement in ventral cervical roots and cauda equina. Furthermore, CSF confirmed protein-cytological dissociation (2 cells | 83 proteins) and nerve conduction study showed acute motor axonal neuropathy (AMAN). During hospitalization, the patient received 5 days course of immunoglobulin 2g/kg with good evolution, completely recovering from pain and paresis.

Discussion: Guillain Barré syndrome (GBS) is an acute immune-mediated polyradiculopathy and, in its classic form, is characterized by muscle weakness with ascending symmetric evolution and the presence of hypo or areflexia. Recent reviews, however, bring cases of GBS variants with normal or increased reflexes. In most of these cases, nerve conduction studies show acute motor axonal neuropathy (AMAN). Preservation of sensory afferent arc of the stretch reflex and the involvement of only a part of axons is one explanation for the preservation of the reflex and is a sign of good prognosis with early recovery.

Final Comments: Muscle stretching reflexes finding in cases of GBS has been rarely reported in literature. This report draws attention to the need of thinking about the diagnosis even with the presence of reflexes, and also warns about the need to revise the current diagnostic criteria.

 

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Publication History

Article published online:
12 May 2025