Disclosures: Miguel E. Velez, MD: Nothing to disclose

Case Description: Case of a 66-year-old male with history of hypertension and OSA that suffered a fall down six stairs with loss of consciousness resulting in multifocal bifrontal hemorrhagic contusions, subarachnoid hemorrhage (SAH) and subdural hematoma (SDH) adjacent to the anterior falx. Patient was subsequently transferred for rehabilitation where his course was complicated by progressive weakness and functional decline. Follow-up HCT and spine MRI demonstrated expected evolution of previously mentioned findings but no new intracranial/spine process to explain findings. Physical exam revealed intact sensation and cranial nerves but was positive for 3/5 strength in RUE, 4-/5 LUE and trace to no activation noted in BLE along with absent reflexes.

Setting: Inpatient

Patient: 66-year-old male with history of hypertension and OSA with recent TBI complicated by weakness.

Assessment/Results: LP revealed: Xanthochromia; WBC 44; RBC 677; Protein 398; Glucose 54. Further evaluation with electrodiagnostic studies showed evidence of an ongoing demyelinating polyradiculoneuropathy as evidenced by slow conduction velocity, conduction block and temporal dispersion, and absent/prolonged F waves. Needle electromyography with findings of active denervation on chronic re-innervation in the RLE muscles. These findings are favored to represent acute/subacute inflammatory demyelinating polyradiculoneuropathy.

Discussion: Based on the clinical findings and diagnostic studies patient was diagnosed with Guillain-Barré Syndrome and subsequently received 5 days of IV Immunoglobulin). GBS is an acute demyelinating polyneuropathy which follows acute insult such as gastrointestinal infection in close to two-thirds of cases. Reports of GBS following surgical procedures have been reported, mainly cranial, gastrointestinal and vascular procedures, but cases following head injury are exceedingly rare and underlying pathophysiology unclear. This patient’s clinical picture was further complicated by his bilateral frontal lobe injuries which caused him difficulty following instructions and engaging in nursing and therapy.

Conclusion: GBS is not commonly associated with TBI but should be considered in the differential of a patient presenting with progressive weakness.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/unusual-case-of-progressive-weakness-following-a-traumatic-brain-injury-a-case-report/