Guillain-Barré Syndrome With Asymmetrical Weakness in a Patient With Charcot-Marie-Tooth Disease Type 1A

TL;DR

A man with a pre-existing nerve condition developed a rare form of Guillain-Barré Syndrome, showing unusual one-sided weakness and responding well to treatment.

Contribution

This case adds to the limited understanding of Guillain-Barré Syndrome co-occurring with Charcot-Marie-Tooth disease and emphasizes the need for early diagnosis and treatment.

Findings

The patient showed atypical asymmetrical weakness in Guillain-Barré Syndrome despite having Charcot-Marie-Tooth disease.

Intravenous immunoglobulin treatment led to significant recovery in the patient.

The case underscores the importance of considering acute treatable causes even in the presence of chronic neuropathy.

Abstract

A man in his 60s presented with acute, progressive right lower limb weakness, low back pain, and paraesthesia. Neuroimaging ruled out spinal cord and central pathology. Cerebrospinal fluid analysis revealed albumin-cytological dissociation, and nerve conduction studies confirmed Guillain-Barré syndrome (GBS) superimposed on Charcot-Marie-Tooth disease type 1A (CMT1A). There was no preceding infection or ganglioside antibody positivity. His weakness progressed rapidly, resulting in flaccid paralysis of the right leg. He received intravenous immunoglobulin with marked clinical improvement and regained independent mobility by follow-up. This case is notable for its atypical, asymmetrical presentation of GBS in the context of pre-existing hereditary neuropathy, posing diagnostic challenges. It contributes to the limited literature on overlapping GBS and CMT1A and reinforces the importance of early investigation and immunotherapy in non-classical cases. The case highlights that reflex loss and chronic neuropathy should not preclude consideration of acute treatable causes.

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