Case Report

A Missed Diagnosis of Guillain-Barre Syndrome Masquerading as Stroke in an Acute Medical Unit: A Case Report

Abstract

An elderly woman aged 66 presented to a general hospital with left-sided facial paresis, bilateral lower limb weakness, and back pain. After undergoing clinical assessments and investigations, she was diagnosed and treated as a case of acute stroke. Two weeks later, she was repatriated to our hospital for neuro-rehabilitation. Unconvinced, we revisited her clinical history and, after a thorough physical examination, made a clinical diagnosis of Guillain- Barre Syndrome (GBS), i.e., confirmed by electrophysiological studies. She was treated with intravenous immunoglobulin and made a complete recovery 6 weeks later.

This case highlights an infrequent presentation of GBS as a stroke-mimic. It re-emphasizes the need to maintain a high index of clinical suspicion for similar expressions, especially in busy acute medical units. Such cases are easily missed if basic clinical skills, such as good history- taking and thorough physical examination, are glossed over. Despite time constraints, these skills are indispensable in clinical practice.

[1] Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, et al. Diagnosis and management of Guillain- Barré syndrome in ten steps. Nature Reviews Neurology. 2019; 15:671-83. [DOI:10.1038/s41582-019-0250-9] [PMID] [PMCID]
[2] Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. The Lancet. 2016; 388(10045):717-27. [DOI:10.1016/S0140- 6736(16)00339-1] [PMID]
[3] McGillicuddy, DC, Walker O, Shapiro NI, Edlow JA. Guillain- Barre syndrome in the emergency department. Annals of Emer- gency Medicine. 2006; 47(4):390-93. [DOI:10.1016/j.anne- mergmed.2005.05.008] [PMID]
[4] Hughes RAC, Cornblath DR, Willison HJ. Guillain-Barré syndrome in the 100 years since its description by Guillain, Barré and Strohl. Brain. 2016; 139(11):3041-7. [DOI:10.1093/brain/aww247] [PMID]
[5] Assessment and management of Guillain-Barre syndrome in the context of Zika virus infection; Interim guidance update. Geneva World Health Organization;2016. https://apps.who.int/iris/bit- stream/handle/10665/204474/WHO_ZIKV_MOC_16.4_eng.pdf;j sessionid=2C792F5C9534711DEB2268B9F40DBB75?sequence=1
[6] Kılıç B, Güngör S, Özgör B. Clinical, electrophysiological findings and evaluation of prognosis of patients with Guillain-barré syndrome. The Turkish Journal of Pediatrics.2019; 61(2):200-8. [DOI:10.24953/ turkjped.2019.02.008] [PMID]
Files
IssueVol 6 No 6 (2021): November-December QRcode
SectionCase Report(s)
Keywords
Guillain-Barre syndrome Autoimmune inflammatory demyelinating polyneuropathy Acute autoimmune neuropathy Acute infectious polyneuritis Acute stroke Cerebrovascular accident

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How to Cite
1.
Madu A, Moqsith M, Raoof A. A Missed Diagnosis of Guillain-Barre Syndrome Masquerading as Stroke in an Acute Medical Unit: A Case Report. CRCP. 2023;6(6):235-238.