214 - Residual Unilateral Lower Extremity Weakness As A Late Sequelae of Asymmetric GBS

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

JF

Jeremy Frank, MD

Resident
Metropolitan/ New York Medical College
New York, New York, United States

Co-Author(s)

AF

Azadeh Fischer, MD

Resident
NYMC-Metropolitan
New York, New York, United States
MA

Marlou Abril, DO

New York Medical College/Metropolitan Hospital Center
Astoria, New York, United States
OS

Ozan Soyer, MD

Resident Physician
New York Medical College / Metropolitan Hospital
Bronx, New York, United States
IS

Iliana Sanchez, MD

Director of Outpatient services
Metropolitan
New York, New York, United States

Submitter(s)

JF

Jeremy Frank, MD

Metropolitan/ New York Medical College
New York, New York, United States

Case Diagnosis: Guillain-Barré Syndrome (GBS)

Case Description: We present a case of a 46-year-old woman who developed a diarrheal syndrome, followed by recurrent lumbar pain, sensory changes, and progressive asymmetric weakness, predominantly affecting the right lower extremity. Initial electrodiagnostic studies performed six weeks after symptom onset demonstrated a length-dependent axonal sensorimotor polyneuropathy, most pronounced in the lower limbs. A repeat study one year later revealed persistent axonal and sensorimotor deficits with only partial recovery, worse in the right lower extremity. Despite these findings, GBS was not recognized at the time of presentation. The diagnosis was established retrospectively. This delay underscores the diagnostic challenges of atypical GBS manifestations. The patient continues to experience persistent right-sided motor deficits and functional limitations, highlighting the heterogeneity of recovery trajectories

Discussions:
GBS is an immune-mediated polyradiculoneuropathy that classically presents with rapidly progressive, symmetric, ascending weakness. Atypical patterns—including asymmetric or persistent unilateral weakness—are increasingly recognized and may complicate diagnosis and rehabilitation planning. Although most people regain independent ambulation, up to 20% experience long-term functional deficits such as foot drop and weakness, necessitating orthotic management and prolonged therapy.

This case illustrates the broad spectrum of GBS and emphasizes the importance of maintaining high suspicion for atypical presentations, particularly when patients present with unexplained or asymmetric neurological deficits. From a rehabilitation perspective, management must be individualized and multidisciplinary, prioritizing functional restoration, orthotic intervention for residual deficits, and psychological support to address fatigue, anxiety, and adaptation to chronic disability. Evidence supports the role of higher-intensity, coordinated inpatient and ambulatory rehabilitation for optimizing outcomes, with long-term follow-up allows timely adjustment of therapy and assistive devices.

Conclusions:
In conclusion, atypical GBS presentations require tailored rehabilitation strategies. For physiatry, this underscores the essential role of comprehensive, person-centered rehabilitation planning - including orthotic support, physical therapy, and psychological interventions to maximize functionality and participation in daily life.