目的

探讨以单侧肢体无力为首发症状的吉兰-巴雷综合征（GBS）的临床诊断特征并探讨其潜在机制。

方法

回顾性分析2024年7月24日济宁医学院附属医院神经内科收治的1例以单侧肢体无力起病的GBS患者的临床资料，并复习相关文献。

结果

患者女性，66岁，主因“左下肢无力5h”入院，既往有胸椎压缩性骨折（胸12）术后、左乳腺癌术后病史，发病前4d有发热伴腹泻。入院头颅MRI未见新发梗死灶，且给予抗血小板、改善脑循环、减轻脑组织损伤等治疗后未见改善。入院后第4天左下肢无力较前加重，并出现右下肢无力。脑脊液示白细胞计数4×10⁶/L，蛋白0.51g/L，脑脊液一般细菌涂片、抗酸杆菌涂片、真菌涂片、墨汁染色均未见异常。抗神经节苷脂（GM1、GM1b、Ga1NAc-GD1a、GD1a、GD1b、GQ1b和GT1a）IgG抗体为阴性。下肢神经电生理示左胫神经、左腓总神经波幅显著降低，左胫神经传导速度轻度减慢。患者最终诊断为GBS，给予血浆置换后患者症状明显缓解。

结论

GBS可表现为单侧肢体无力起病，临床需与脑梗死相鉴别。

Objective

To investigate the clinical diagnostic characteristics and potential pathophysiological mechanisms of Guillain-Barré syndrome （GBS） manifesting with unilateral limb weakness as the initial presentation.

Methods

A retrospective analysis was conducted on the clinical data of a GBS patient with unilateral limb weakness who was admitted to the Department of Neurology of the Affiliated Hospital of Jining Medical University on July 24， 2024， and the relevant literature was reviewed.

Results

The patient was a 66-year-old female who was admitted mainly due to "left lower extremity weakness for 5 hours". Her past medical history included thoracic compression fracture （T₁₂） surgery and left breast cancer surgery.Four days before the onset of the disease， she had fever accompanied by diarrhea. No new infarction foci were found on the cranial MRI upon admission， and no improvement was noted after treatment with antiplatelet therapy， cerebral circulation enhancement， and mitigation of brain tissue injury. On the fourth day after admission， the weakness of the left lower extremity worsened， and weakness of the right lower extremity occurred. Cerebrospinal fluid analysis showed a white blood cell count of 4×10⁶/L and a protein concentration of 0.51g/L. Gram staining， acid-fast staining， fungal staining， and India ink staining of the cerebrospinal fluid revealed no abnormalities. Anti-ganglioside （GM1， GM1b， GalNAc-GD1a， GD1a， GD1b， GQ1b，and GT1a） IgG antibodies were negative. Electrophysiological studies of the lower limbs demonstrated a significant reduction in the amplitudes of the left tibial and left common peroneal nerves， with mildly decreased conduction velocity in the left tibial nerve. The patient was finally diagnosed with GBS. After plasma exchange， the patient′s symptoms were significantly relieved.

Conclusion

GBS that begins with unilateral limb weakness needs to be differentiated from cerebral infarction.