# Acute Urinary Retention and Guillain-Barré Syndrome: A Zebra or a Horse

## TL;DR

This case report describes a confusing presentation of Guillain-Barré Syndrome with acute urinary retention, highlighting the importance of thorough workup in differential diagnosis.

## Contribution

The paper presents a unique case of GBS with atypical symptoms, emphasizing diagnostic challenges and the need for continued evaluation.

## Key findings

- The patient's symptoms initially suggested cauda equina syndrome but were later attributed to GBS.
- The case highlights diagnostic confusion and the importance of not anchoring on initial probabilities.
- It underscores potential errors in observation medicine when dealing with atypical presentations.

## Abstract

Acute immune-mediated polyneuropathies are grouped under the umbrella term Guillain-Barré syndrome (GBS). GBS can often present with variable clinical findings. Typical features of GBS include a progressive, symmetric muscle weakness and absent deep tendon reflexes. This case report describes a confusing presentation in a patient who had been having preceding back pain prior to the onset of a worsening back pain associated with autonomic symptoms of GBS with urinary retention. This caused initial diagnostic confusion with cauda equina syndrome being the leading diagnostic possibility until ruled out with magnetic resonance imaging. The case demonstrates the importance of not anchoring completely on the initial diagnostic probability but on continuing the workup of acute urinary retention associated with other neurologic symptoms as cauda equina was effectively ruled out. The case also highlights the sometimes problematic errors that can occur with observation medicine.