Unilateral XIIth cranial nerve palsy as the only presenting symptom of Guillain-Barre syndrome – a case report

Summary
Background: Acute inflammatory demyelinating polyradiculoneuropathy (AIDP), also called Guillain-Barre syndrome (GBS) is a commonly encountered neurological problem manifested by motor weakness, areflexia, parasthesias with slight sensory loss, and increased protein in CSF with paucity of cells (albumino cytological dissociation). It usually starts with lower limb weakness, which ascends
proximally over hours to several days. Less often, weakness may begin in proximal or cranial nerve innervated muscles.
Case Report: A 38-year-old male presented to our Out-Patient Department with acute onset deviation of the tongue to the right, preceded by progressively ascending paraesthesia for 3 days. The findings on neurological examination were unremarkable except for right-sided hypoglossal nerve palsy. Laboratory investigations and imaging modalities were non-contributory. On the 7th postadmission day, he developed acute onset respiratory distress with Forced Vital Capacity of 750ml, which subsided spontaneously after about 30mins. On the next day, the patient developed acute onset flaccid paraplegia without any sensory abnormalities. Cerebrospinal fluid analysis and electrophysiological study were consistent with the diagnosis of AIDP.
Conclusions: Isolated XIIth cranial nerve palsy is a relatively rare presentation in GBS. Not all cases of GBS will present with the classic features of flaccid ascending paralysis, as traditionally advocated.

Keywords: Acute inflammatory demyelinating polyradiculoneuropathy, Guillain-Barre Syndrome, Areflexia, Albumino cytological dissociation, Hypoglossal Nerve, Forced Vital Capacity, Flaccid, Cerebrospinal Fluid