Acute-Onset Quadriplegia Presenting With Hyperreflexia: A Dilemma in Diagnosis

TL;DR

This paper presents a rare case of Guillain-Barré syndrome in a 37-year-old man with unusual hyperreflexia, challenging typical diagnostic expectations.

Contribution

The case highlights an atypical presentation of GBS with hyperreflexia, uncommon in the Indian subcontinent.

Findings

The patient showed hyperreflexia in upper limbs, which is not typical for GBS.

Nerve conduction studies confirmed axonal and demyelinating motor neuropathy.

The patient refused plasmapheresis after an allergic reaction to immunoglobulin therapy.

Abstract

An autoimmune polyradiculoneuropathy, Guillain-Barré syndrome (GBS) is an acute, rapidly progressive, and fulminant one. Rapidly developing motor weakness along with absent reflexes, with or without sensory impairment, is the hallmark of GBS. GBS is never a hereditary entity; it is always acquired by the individual. Here, we present an interesting case of GBS in a 37-year-old male patient presenting with lower limb weakness for one day which had progressed to upper limb weakness in a day. There was a history of fever and loose stools four days back. On examination, vitals were within normal limits including single breath count. Central nervous system (CNS) examination revealed as follows: bicep jerk, tricep jerk, and supinator jerk were National Institute of Neurological Disorders and Stroke (NINDS) scale grade 2 in bilateral upper limbs. Knee jerk was NINDS scale grade 3 in bilateral lower limbs, which was unusual considering that GBS presents with areflexia or reduced reflexes. Ankle jerk was absent in bilateral lower limbs. Plantars were mute bilaterally. Nerve conduction study was suggestive of axonal and demyelinating motor neuropathy involving all four limbs. The patient was planned for intravenous immunoglobulin at a dose of 2 g/kg/day for five days but developed an allergic reaction to the first dose; hence, the therapy was discontinued, and the option of plasmapheresis was given to which the patient refused. This is a report of a case of GBS with hyperreflexia which is an uncommon entity in the Indian subcontinent.