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Xue J, Song Z, Li F, Yi Z, Yang C, Liu K, Zhang Y. Guillain-Barré syndrome with unilateral peripheral facial paralysis in a Chinese child. Int J Dev Neurosci 2022; 82:548-553. [PMID: 35993140 DOI: 10.1002/jdn.10225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/05/2022] [Accepted: 08/15/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy with the classic presentation of acute onset neurological symptoms preceded by an infective illness, followed by progressive limb weakness. Unilateral facial paralysis is rarely seen in GBS. CASE PRESENTATION We reported a child presented with unilateral facial paralysis, limited outward movement of one eye and unilateral lower limb weakness, who was later diagnosed to have GBS. Through reviewing the patients with similar presentation reported previously, we found that the onset time of unilateral facial weakness in relation to other presentations of GBS seemed to be variable, which could be later or earlier than other symptoms, or concomitant. Most of the patients had a relatively good outcome within two weeks to twelve months of follow-up. CONCLUSIONS Unilateral facial paralysis may be a feature of GBS, albeit a rare thing. Recognizing the clinical patterns of such atypical variants of GBS allows for more timely and accurate diagnosis, and for treatment to be initiated without delay.
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Affiliation(s)
- Jiao Xue
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zhenfeng Song
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Fei Li
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zhi Yi
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chengqing Yang
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Kaixuan Liu
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ying Zhang
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Mason MC, Liaqat A, Morrow J, Basso R, Gujrati Y. Bilateral Facial Nerve Palsy and COVID-19 Vaccination: Causation or Coincidence? Cureus 2021; 13:e17602. [PMID: 34522557 PMCID: PMC8425028 DOI: 10.7759/cureus.17602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022] Open
Abstract
Bell's palsy is a mononeuropathy of the facial nerve that typically causes unilateral facial paralysis. The incidence of unilateral Bell's palsy is not uncommon, but sequential or simultaneous bilateral Bell's palsy is exceedingly rare. While unilateral Bell's palsy is oftentimes idiopathic, bilateral Bell's palsy is almost exclusively explained by an identifiable trigger. In pre-clinical trials, Bell's palsy cases were recorded at higher rates in the vaccine cohort than the placebo cohort. Herein, we present a case of isolated sequential bilateral Bell's palsy that after an extensive workup, proved to be idiopathic. Notably, in the setting of a recent coronavirus disease 2019 (COVID-19) vaccine and absence of identifiable etiology, our case highlights a potential correlation of the COVID-19 vaccine and bilateral Bell's palsy.
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Affiliation(s)
- Matthew C Mason
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Adnan Liaqat
- Internal Medicine, Southeast Health Medical Center, Dothan, USA
| | - Jamie Morrow
- Internal Medicine, Southeast Health Medical Center, Dothan, USA
| | - Rafaela Basso
- Internal Medicine, Southeast Health Medical Center, Dothan, USA
| | - Yogesh Gujrati
- Neuro-endovascular Surgery, Southeast Health Medical Center, Dothan, USA
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Khaja M, Gomez GPR, Santana Y, Hernandez N, Haider A, Lara JLP, Elkin R. A 44-Year-Old Hispanic Man with Loss of Taste and Bilateral Facial Weakness Diagnosed with Guillain-Barré Syndrome and Bell's Palsy Associated with SARS-CoV-2 Infection Treated with Intravenous Immunoglobulin. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e927956. [PMID: 33128540 PMCID: PMC7643409 DOI: 10.12659/ajcr.927956] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND This case report is of a patient who presented with loss of taste and facial weakness and was diagnosed with Guillain-Barre syndrome (GBS) and Bell's palsy, associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. GBS is a neurological emergency defined as acute inflammatory demyelinating polyneuropathy. The patient responded to intravenous immunoglobulin (IVIG) treatment. CASE REPORT We present the case of a 44-year-old Hispanic man who came for evaluation of bilateral facial weakness and lack of taste sensation. He had lower motor neuron facial weakness. His head computed tomography and brain magnetic resonance imaging scans did not show any pathological abnormalities. He tested positive for SARS-CoV-2 by a nasopharyngeal swab reverse transcription polymerase chain reaction (RT-PCR) test. Cerebrospinal fluid (CSF) analysis via lumbar puncture revealed elevated protein levels, no leukocytes, and a negative Gram stain. The CSF RT-PCR test for SARS-CoV-2 was negative. PCR tests of the CSF for other viral infections were negative. A diagnosis of GBS was made, and he was treated successfully with IVIG. After the fourth dose of IVIG, the patient was able to close his eyes, frown, show his teeth, and smile. CONCLUSIONS Our case is rare because the patient did not present with lower extremity weakness, but only with bilateral Bell's palsy. Physicians should be aware of GBS because it is a neurological emergency for which COVID-19 can be a risk factor. Early diagnosis and treatment of GBS can prevent neurological disability.
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Affiliation(s)
- Misbahuddin Khaja
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System Affiliated with the Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Gabriella P Roa Gomez
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System Affiliated with the Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Yaneidy Santana
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System Affiliated with the Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Nolberto Hernandez
- Department of Medicine, BronxCare Health Center Affiliated with The Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Asim Haider
- Department of Medicine, BronxCare Health Center Affiliated with The Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Jose Luis Perez Lara
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System Affiliated with the Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Rene Elkin
- Department of Neurology, BronxCare Health Center Affiliated with The Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
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Turco EC, Piccolo B, Pisani F. Unilateral Facial Palsy in an Adolescent with Guillain–Barré Syndrome. JOURNAL OF PEDIATRIC NEUROLOGY 2020. [DOI: 10.1055/s-0040-1716911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractGuillain–Barré syndrome (GBS) is the most common and most severe acute demyelinating polyneuropathy with ∼0.8 to 1.1/100,000 incidence in pediatric population. Unlike adult patients, incidence of facial nerve involvement in children with GBS has not yet been determined possibly because of rare use of magnetic resonance imaging in childhood-onset GBS. In the present study, we describe a girl with GBS who presented unilateral peripheral facial palsy, confirmed by neuroimaging and electrophysiological evaluation. We suggest that both neuroimaging and detailed electrophysiological evaluation should be integrated into the work-up of such patients. We also wish to highlight the importance of evaluating cranial nerve involvement as a potential indicator of severity of disease.
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Affiliation(s)
- Emanuela Claudia Turco
- Child Neuropsychiatric Unit, Department of Maternal and Child Health, Parma University Hospital, Parma, Italy
| | - Benedetta Piccolo
- Child Neuropsychiatric Unit, Department of Maternal and Child Health, Parma University Hospital, Parma, Italy
| | - Francesco Pisani
- Child Neuropsychiatric Unit, Department of Maternal and Child Health, Parma University Hospital, Parma, Italy
- Neuroscience Section, Child Neuropsychiatric Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Yadav P, Dhaka S, Chaudhary R, Damke S, Lohiya S. A Rare Case Report of Guillain-Barré Syndrome Presenting as Unilateral Facial Palsy with Isolated acute Bulbar Palsy. J Pediatr Neurosci 2020; 15:157-159. [PMID: 33042253 PMCID: PMC7519738 DOI: 10.4103/jpn.jpn_129_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/16/2020] [Accepted: 01/30/2020] [Indexed: 11/26/2022] Open
Abstract
Guillain–Barré syndrome (GBS) is an immune-mediated acute inflammatory polyradiculoneuropathy and it is the most common cause of acute flaccid paralysis worldwide. There are some rare variants of GBS, which may be easily missed unless suspected. Here we present a case of GBS presenting as isolated acute bulbar palsy. A 10-month-old infant, known case of tricuspid atresia with pulmonary stenosis, presented with left-sided lower motor neuron type of facial palsy and palsy of bilateral glossopharyngeal and vagus nerve of 2 weeks’ duration. On detailed neurological examination, motor and sensory system were normal. Nerve conduction study showed demyelinating motor neuropathy and hence the diagnosis of GBS was made. To the best of our knowledge, no case of isolated bulbar palsy due to GBS in infancy has been reported.
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Affiliation(s)
- Prachi Yadav
- Department of Pediatrics, Jawaharlal Nehru Medical College (JNMC), Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Sahil Dhaka
- Department of Pediatrics, Jawaharlal Nehru Medical College (JNMC), Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Richa Chaudhary
- Department of Pediatrics, Jawaharlal Nehru Medical College (JNMC), Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Sachin Damke
- Department of Pediatrics, Jawaharlal Nehru Medical College (JNMC), Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Sham Lohiya
- Department of Pediatrics, Jawaharlal Nehru Medical College (JNMC), Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
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Noh HR, Lee KH. Guillain-Barré Syndrome Presenting with Unilateral Peripheral Facial Palsy in an Infant. ANNALS OF CHILD NEUROLOGY 2020. [DOI: 10.26815/acn.2019.00255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Nishiguchi S, Branch J, Tsuchiya T, Ito R, Kawada J. Guillain-Barré Syndrome: A Variant Consisting of Facial Diplegia and Paresthesia with Left Facial Hemiplegia Associated with Antibodies to Galactocerebroside and Phosphatidic Acid. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1048-1052. [PMID: 28966341 PMCID: PMC5633102 DOI: 10.12659/ajcr.904925] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/27/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND A rare variant of Guillain-Barré syndrome (GBS) consists of facial diplegia and paresthesia, but an even more rare association is with facial hemiplegia, similar to Bell's palsy. This case report is of this rare variant of GBS that was associated with IgG antibodies to galactocerebroside and phosphatidic acid. CASE REPORT A 54-year-old man presented with lower left facial palsy and paresthesia of his extremities, following an upper respiratory tract infection. Physical examination confirmed lower left facial palsy and paresthesia of his extremities with hyporeflexia of his lower limbs and sensory loss of all four extremities. The differential diagnosis was between a variant of GBS and Bell's palsy. Following initial treatment with glucocorticoids followed by intravenous immunoglobulin (IVIG), his sensory abnormalities resolved. Serum IgG antibodies to galactocerebroside and phosphatidic acid were positive in this patient, but not other antibodies to glycolipids or phospholipids were found. Five months following discharge from hospital, his left facial palsy had improved. CONCLUSIONS A case of a rare variant of GBS is presented with facial diplegia and paresthesia and with unilateral facial palsy. This rare variant of GBS may which may mimic Bell's palsy. In this case, IgG antibodies to galactocerebroside and phosphatidic acid were detected.
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Affiliation(s)
- Sho Nishiguchi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Joel Branch
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Tsubasa Tsuchiya
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Ryoji Ito
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Junya Kawada
- Department of Neurology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
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Iqbal M, Sharma P, Charadva C, Prasad M. Rare encounter of unilateral facial nerve palsy in an adolescent with Guillain-Barré syndrome. BMJ Case Rep 2016; 2016:bcr-2015-213394. [PMID: 26823357 DOI: 10.1136/bcr-2015-213394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Unilateral facial nerve palsy is rarely encountered in Guillain-Barré syndrome (GBS). We report a case of an adolescent girl who presented with peripheral ascending weakness, preceded by Campylobacter jejuni infection. After treatment with intravenous immunoglobulin, the peripheral weakness improved. Electro-diagnostic testing confirmed axonal dysfunction and the patient was positive for antiganglioside antibodies. However, the patient developed unilateral left-sided facial weakness. She was managed with further intravenous immunoglobulin and intensive physiotherapy. The outcome for facial palsy was very good, with almost complete resolution after 2 weeks.
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Affiliation(s)
| | | | | | - Manish Prasad
- Department of Paediatric Neurology, University Hospitals of Leicester, Leicester, UK
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Ray S, Jain PC. Acute bulbar palsy plus syndrome: A rare variant of Guillain-Barre syndrome. J Pediatr Neurosci 2016; 11:322-323. [PMID: 28217155 PMCID: PMC5314846 DOI: 10.4103/1817-1745.199480] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Guillain-Barre syndrome (GBS) is the most common cause of acute flaccid paralysis worldwide both in adult and pediatric population. Although flaccid paralysis is the hallmark of this disease, there are some rare variants which may be easily missed unless suspected. Here, we present a very rare variant of GBS - acute bulbar palsy plus syndrome in a pediatric patient. A 13-year-old female child presented with right-sided lower motor neuron type of facial palsy and palsy of bilateral glossopharyngeal and vagus nerve of 2 weeks duration. On detailed neurological examination, motor and sensory system were normal, but the deep tendon reflexes were absent universally. Nerve conduction study showed demyelinating motor neuropathy. Based on typical clinical course and electrophysiological studies, the diagnosis was made. To the best of our knowledge, this is the first pediatric case of unilateral facial palsy with bulbar involvement without any motor abnormality.
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Affiliation(s)
- Sanghamitra Ray
- Department of Pediatrics, Cantonment General Hospital, New Delhi, India
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Albiol-Pérez S, Forcano-García M, Muñoz-Tomás MT, Manzano-Fernández P, Solsona-Hernández S, Mashat MA, Gil-Gómez JA. A novel virtual motor rehabilitation system for Guillain-Barré syndrome. Two single case studies. Methods Inf Med 2015; 54:127-34. [PMID: 25609504 DOI: 10.3414/me14-02-0002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 11/02/2014] [Indexed: 11/09/2022]
Abstract
INTRODUCTION This article is part of the Focus Theme of Methods of Information in Medicine on "New Methodologies for Patients Rehabilitation". OBJECTIVES For Guillain-Barré patients, motor rehabilitation programs are helpful at the onset to prevent the complications of paralysis and in cases of persistent motor impairment. Traditional motor rehabilitation programs may be tedious and monotonous, resulting in low adherence to the treatments. A Virtual Motor Rehabilitation system has been tested in Guillain-Barré patients to increase patient adherence and to improve clinical results. METHODS Two people with Guillain-Barré performed 20 rehabilitation sessions. We tested a novel system based on Motor Virtual Rehabilitation in three periods of time (baseline evaluation, final evaluation, and follow-up. In the training program, the participants carried out a specific treatment using the Active Balance Rehabilitation system (ABAR). The system is composed of customizable virtual games to perform static and dynamic balance rehabilitation. RESULTS Significant improvements in clinical results were obtained by both participants, with significant results in the static balance clinical test of the Anterior Reach test in the standing position and unipedal stance time. Other significant results were found in dynamic balance clinical tests in the Berg Balance Scale test and the 30-second Sit-to-Stand test. With regard to acceptance of the system, both patients enjoyed the experience, and both patients thought that this system was helpful for their rehabilitation. CONCLUSIONS The results show that Virtual Motor Rehabilitation for Guillain-Barré patients provides clinical improvements in an entertaining way.
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Affiliation(s)
- S Albiol-Pérez
- Sergio Albiol-Pérez, Dpto. de Informática e Ingeniería de Sistemas, Universidad de Zaragoza, Ciudad Escolar s/n, 44003, Teruel, Spain, E-mail:
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Bhargava A, Banakar BF, Pujar GS, Khichar S. A study of Guillain-Barré syndrome with reference to cranial neuropathy and its prognostic implication. J Neurosci Rural Pract 2014; 5:S43-7. [PMID: 25540538 PMCID: PMC4271381 DOI: 10.4103/0976-3147.145200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Focused studies on cranial neuropathy in Guillain-Barré syndrome (GBS) and its prognostic implication are not done previously. AIM To study the clinical profile of GBS patients with special reference to cranial neuropathy and its prognostic implication. MATERIALS AND METHODS The study included 61 patients with GB syndrome, fulfilling Asbury Cornblath's criteria for GB syndrome. A pre-designed semi-structured questionnaire was used to obtain data regarding demographic profile and clinical profile. All patients underwent detailed neurological examination, investigations including nerve conduction studies and CSF examination and treated according to the severity of the illness. Patients were followed up for 6 months. During analysis two groups were made depending on cranial nerve involvement, and compared with respect to various parameters. RESULTS Out of 61 patients 38 (62.3%) patients had cranial nerve palsies, in that 25 had multiple cranial nerve palsies, and 13 had single isolated nerve palsy. A majority of 30 (49.2%) had bulbar palsy, 28 (46%) had facial nerve palsy, and all had bilateral involvement except 3 patients who had unilateral palsy. Hypoglossal nerve involvement was seen in six (10%) patients and four (6.5%) patients had ophthalmoplegia. Only one had bilateral vestibulocochlear nerve palsy. On comparing various clinico-electrophysiological parameters among patients of GB syndrome with and without cranial nerve involvement, the presence of respiratory paralysis, IVIg and ventilatory support requirement had significant association with cranial nerve involvement in GBS. CONCLUSION Our study found a correlation between cranial nerve palsies and severity of the illness. Cranial nerve innervated muscles recover earlier as compared to distal limb muscles. No association was found between outcome at 6 months and cranial nerve involvement.
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Affiliation(s)
- Amita Bhargava
- Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Basavaraj F. Banakar
- Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Guruprasad S. Pujar
- Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Shubhakaran Khichar
- Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
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INALOO S, KATIBEH P. Guillain-barre syndrome presenting with bilateral facial nerve palsy. IRANIAN JOURNAL OF CHILD NEUROLOGY 2014; 8:70-2. [PMID: 24665332 PMCID: PMC3943056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 08/05/2013] [Accepted: 08/06/2013] [Indexed: 11/24/2022]
Abstract
This case study is about an 11-year-old girl with bilateral facial weakness, abnormal taste sensation, and absent deep tendon reflexes of both knees and ankles. However, the muscle power of the lower and upper extremities across all muscle groups was normal. After 2 days, she developed paresthesia and numbness in the lower extremities. Other neurologic examinations, such as fundoscopic evaluation of the retina were normal with the muscle power of both upper- and lower-extremities intact. A lumbar puncture revealed albumincytological dissociation. EMG and NCV were in favor of Guillain-Barre syndrome, for which IVIG was prescribed and the abnormal sensations in the lower limbs rapidly improved. Bilateral facial diplegia without weakness and paresthesia is a variant of Guillain-Barre syndrome that mostly presents with acute onset, rapid progression with or without limb weakness, paresthesia, and decreased or absent DTR and albumin-cytological dissociation.
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Affiliation(s)
- Sorour INALOO
- Pediatric Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pegah KATIBEH
- Pediatric Department, Shiraz University of Medical Sciences, Shiraz, Iran
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