Disclosures: Eduardo J. Maldonado-Colon, MD: Nothing to disclose

Case Description: 55-year-old male with history of hypertension, diabetes, and asthma, who suffered a gastrointestinal infection in August 2018. Two weeks after viral symptoms resolved patient presented with right lower extremity weakness, which progressed rapidly to involve the right upper extremity as well. Work-up for cerebrovascular accident was ordered including head CT and MRI, carotid Doppler, and echocardiogram; which showed unremarkable results. Further investigation with lumbar puncture revealed albuminocytologic dissociation, and serum anti-GM1 IgG elevated, 1:51200. Nerve conduction study revealed acute motor axonal neuropathy (AMAN). Hence, patient underwent therapy with intravenous immunoglobulins as well as intensive treatment in acute inpatient rehabilitation ward with excellent response.

Setting: Acute Inpatient Rehabilitation Ward, Veterans Hospital.

Patient: 55-year-old male with history of viral syndrome who presented with right hemiparesis 2 weeks after.

Assessment/Results: Electrodiagnostic study (EDX) was performed 8 days after onset of hemiparesis. Study did not strictly meet electrodiagnostic criteria for Acute Inflammatory Demyelinating Polyneuropathy. EDX 2 weeks later was remarkable for AMAN with more than 80% reduction in amplitudes, absence and latency prolongation of F-waves. Upon discharge from inpatient rehabilitation, patient’s functional status improved. He achieved antigravity strength in right hemibody, modified independence in transfers, and ambulated at least 250 feet with rolling walker.

Discussion: This case represents a very rare clinical presentation of AMAN. This patient presented with a right-sided hemiparesis that mimicked a stroke, which ultimately resulted in a delay in diagnosis and management. In addition, patient presented with diminished but preserved patellar reflexes initially, which is also uncharacteristic of AMAN. There are very few reported cases in literature of AMAN presenting with hemiparesis. In this particular case, patient responded well with high intensity rehabilitation and intravenous immunoglobulins.

Conclusion: Atypical Guillain-Barre syndrome may present with asymmetric weakness mimicking a stroke. Treatment with IVIG and intensive rehabilitation seems to improve functional outcomes.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-cerebrovascular-accident-or-inflammatory-demyelinating-polyneuropathy-atypical-guillain-barre-presentation-a-case-report/