Akut bulber güçsüzlükle prezente olan guillian-barre sendromu olgusu

Guillain-Barre sendromu (GBS) akut başlangıçlı, asendan ekstremitegüçsüzlüğü ve arefleksi ile karakterizedir. GBSnun birçok nadir görülenvaryantı tanımlanmıştır. Faringoservikobrakiyal (FSB) varyant bunlardanbiri olup, orofarinks, boyun ve üst ekstremite kaslarında güçsüzlük ilegider. Miller Fisher sendromu (MFS) ise ataksi, arefleksi ve eksternaloftalmoparezi ile seyreden bir diğer subtipidir. Olgumuz bulber kasgüçsüzlüğü ve hafif pitoz ile prezente olmuştu. Nörolojik muayenesindefaringeal ve palatal kaslarda zafiyet ve jeneralize bir arefleksi tespit edilmiş olup, ekstremite güçsüzlüğü, oftalmoparezi veya ataksi saptanmamıştı.Lomber ponksiyonda BOS proteini yüksek bulundu. EMGsindedemyelinizan özellik gösteren yaygın sensorimotor periferik nöropatisaptandı. Hasta intravenöz immunglobulin (IVIg) tedavisi sonrasındatamamen normale döndü. Akut gelişen izole bulber paralizi olgularında, sıkgörülen nörolojik tablolar yanında nadiren de olsa GBS varyantlarınınolabileceği akla gelmeli, bu hastalıklar ayırıcı tanılarımız arasında yeralmalıdır.

Case of guillian-barre syndrome presenting with acute bulbar palsy

Guillain-Barre syndrome (GBS) is characterized by an acute onset of limb weakness and areflexia. There are a few rare variants that have been described and one of them is the pharyngeal-cervical-brachial (PCB) variant. This variant is presenting with oropharynx, neck and proximal upper limb muscles weakness. Another variant Miller-Fisher syndrome (MFS) is presenting with ataxia, areflexia and external ophthalmoplegia. In this patient, the presentation was bulbar involvement and mild ptosis. Neurological examination showed generalized areflexia and there were pharyngeal and palatal muscles weakness. There was no limb weakness, ophthalmoparesis or ataxia. Cerebrospinal fluid examination showed raised protein level. EMG showed demyelinating sensorymotor polyneuropathy. The patient fully recovered after intravenous immunoglobulin (IVIg) treatment. The isolated acute bulbar paralysis cases should be considered as rare variants of GBS, in addition to common neurological statements and this disease should be included in the differential diagnosis.

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