Multiple Sclerosis and other Neurological Conditions
Zachary Armstrong, MD
Resident Physician - PM&R
University of Toledo
Perrysburg, Ohio, United States
Sharleen Suico, MD, FAAPMR
Associate Residency Program Director, Assistant Professor PM&R
University of Toledo
Toledo, Ohio, United States
Zachary Armstrong, MD
University of Toledo
Perrysburg, Ohio, United States
Guillain-Barré Syndrome – Acute Motor Sensory Axonal Neuropathy (AMSAN) Variant
Patient is a 34-year-old male with recent gastrointestinal illness who presented to the hospital with two-day history of bilateral pedal numbness and headache. Patient received migraine cocktail and was discharged home after unremarkable workup.
Patient returned next day with new left upper extremity weakness, and abnormal gait. MRI brain and spine were unremarkable but lumbar puncture revealed albuminocytologic dissociation concerning for Guillain-Barré Syndrome (GBS). Four limb NCS performed during admission was completely non-reactive. Patient diagnosed with GBS acute motor sensory axonal neuropathy (AMSAN) variant. Hospitalization complicated by flaccid quadriparesis, respiratory decline requiring tracheostomy, SIADH and encephalopathy. He completed multiple courses IVIG with mild initial improvement.
Patient discharged to LTAC followed by IPR stay with marked improvement including tracheostomy decannulation, and assisted ambulation. One year from onset patient had residual neuropathic pain and bilateral foot drop, but progressed to independence for ADLs and modified independent ambulation.
GBS is an acute autoimmune condition affecting the peripheral nervous system. The most common subtype of GBS is acute inflammatory demyelinating polyneuropathy (AIDP), however there are other variants which are more rare. It is estimated the axonal variants account for only 5-10% of GBS cases in North America. This case involves the AMSAN variant which is classically more severe than AIDP and carries a worse prognosis. Our patient demonstrates a classic presentation with preceding gastrointestinal illness followed by severe progression to flaccid quadriparesis and acute respiratory failure. However, this case illustrates a positive outcome which is unique given the severity of the condition. After receiving IVIG and extensive therapies the patient progressed to independence with ADLs and modified independent ambulation with AFO.
Our aim is to describe a case with good prognostic outcome involving the rare AMSAN variant of GBS.
