Abstract:
Guillain Barre Syndrome (GBS) is an immune mediated
polyradiculoneuropathy classically characterized by acute
ascending type of motor weakness of limbs with areflexia
but in AMAN variant of GBS preserved or exaggerated
reflex sometimes can occur. We report a 45 year old female
patient who presented with acute flaccid quadriplegia,
bilateral facial lower motor type nerve palsy and bulbar
involvement, initial hyperreflexia of all four limbs and
bilateral plantar extensor response 7 days following an
attack of diarrhoea. Sensory and bowel bladder function
was intact. She was treated with IV immunoglobulin and
IV methylprednisolone. Nerve Conduction study (NCS)
revealed AMAN variant of GBS. All reflexes disappeared
on the 2nd day onward but returned on 21st day of illness
when muscle power also improved. Follow up NCS
confirmed regeneration of nerves of all four limbs. So in
any patient presenting with acute quadriparesis GBS should
be in the differential diagnosis even if there is preserved or
exaggerated deep tendon reflexes.
Key words: Guillain Barre Syndrome, Hyperreflexia, AMAN
variant GBS
(J Banagladesh Coll Phys Surg 2014; 32: 107-109)