A case of Guillain-Barré syndrome starting with unilateral limb weakness and literature review

doi:10.3877/cma.j.issn.2095-655X.2025.02.008

Abstract

Abstract:

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.

Key words: Guillain-Barré syndrome, Dissymmetry, Myasthenia, Autoantibodies, Bloodnerve barrier

Chaoqun Liu, Yuzhong Wang, Guorong Zhang. A case of Guillain-Barré syndrome starting with unilateral limb weakness and literature review[J]. Chinese Journal of Diagnostics(Electronic Edition), 2025, 13(02): 117-121.

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Figures/Tables 4

References 23

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项目	不对称性吉兰-巴雷综合征	脑梗死
发病年龄	6个月至80岁^［9，22］	常＞ 65岁^［23］
前驱事件/危险因素	上呼吸道感染和/或腹泻	高血压病、糖尿病等
起病形式	急性或亚急性，进行性加重	急性，一般不再加重
发病时
肢体无力分布	单侧	单侧
瘫痪	下运动神经元瘫痪	上运动神经元瘫痪
感觉障碍	伴或不伴感觉障碍	多数合并偏身麻木
头颅MRI	无急性病灶	急性期可见DWI高信号
脑脊液检查	可见蛋白-细胞分离现象	一般正常
神经传导检查	周围神经脱髓鞘和/或轴突损害	正常
抗神经节苷脂抗体IgG	抗GM1抗体阳性率高	阴性

项目	不对称性吉兰-巴雷综合征	脑梗死
发病年龄	6个月至80岁^［9，22］	常＞ 65岁^［23］
前驱事件/危险因素	上呼吸道感染和/或腹泻	高血压病、糖尿病等
起病形式	急性或亚急性，进行性加重	急性，一般不再加重
发病时
肢体无力分布	单侧	单侧
瘫痪	下运动神经元瘫痪	上运动神经元瘫痪
感觉障碍	伴或不伴感觉障碍	多数合并偏身麻木
头颅MRI	无急性病灶	急性期可见DWI高信号
脑脊液检查	可见蛋白-细胞分离现象	一般正常
神经传导检查	周围神经脱髓鞘和/或轴突损害	正常
抗神经节苷脂抗体IgG	抗GM1抗体阳性率高	阴性

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