Hu M, Li X, Wong HY, Feng XG, Wang YZ, Zhang GR. Asymmetric limb weakness in Guillain-Barré syndrome: Three case reports. World J Clin Cases 2022; 10(6): 1896-1902 [PMID: 35317159 DOI: 10.12998/wjcc.v10.i6.1896]
Corresponding Author of This Article
Guo-Rong Zhang, Master of Medicine, Chief Doctor, Department of Neurology, The Affiliated Hospital of Jining Medical University, No. 89 Guhuai Road, Jining 272000, Shandong Province, China. rongrong.2.14@163.com
Research Domain of This Article
Clinical Neurology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Feb 26, 2022; 10(6): 1896-1902 Published online Feb 26, 2022. doi: 10.12998/wjcc.v10.i6.1896
Asymmetric limb weakness in Guillain-Barré syndrome: Three case reports
Ming Hu, Xiang Li, Hiu Yi Wong, Xun-Gang Feng, Yu-Zhong Wang, Guo-Rong Zhang
Ming Hu, Xun-Gang Feng, Guo-Rong Zhang, Department of Neurology, The Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
Xiang Li, Department of Rehabilitation, The Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
Hiu Yi Wong, Department of Physiology, Yong Loo Lin School of Medicine, Singapore 536205, Singapore
Yu-Zhong Wang, Department of Medical Research Center and Neurology, The Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
Author contributions: Zhang GR and Hu M reviewed the literature and contributed to manuscript drafting; Li X and Feng XG played a major role in the acquisition of clinical data and the literature search; Wang YZ and Wong HY were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported byTeacher Research Support Foundation of Jining Medical University, No. JYFC2018FKJ140; Natural Science Foundation Youth Project of Shandong Province, No. ZR2020QH110.
Informed consent statement: Informed written consent was obtained from the three patients for publication of this report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Rong Zhang, Master of Medicine, Chief Doctor, Department of Neurology, The Affiliated Hospital of Jining Medical University, No. 89 Guhuai Road, Jining 272000, Shandong Province, China. rongrong.2.14@163.com
Received: July 20, 2021 Peer-review started: July 20, 2021 First decision: October 16, 2021 Revised: October 27, 2021 Accepted: January 19, 2022 Article in press: January 19, 2022 Published online: February 26, 2022
Abstract
BACKGROUND
Guillain-Barré syndrome (GBS) is an autoimmune-mediated peripheral neuropathy characterized by symmetric weakness. Asymmetric weakness in GBS is uncommon and may be easily confused with other differential diagnoses. We herein present three cases of asymmetric GBS and review the literature on this atypical subtype of GBS in order to describe the characteristics of asymmetric GBS and to provide experience for clinicians.
CASE SUMMARY
Different from patients in the previous reports, our patients showed persistent asymmetric limb weakness from the onset to recovery phase. All three patients were serologically positive for antecedent infections. Two of the three cases had IgG antibodies against ganglioside GM1. Two patients received immunotherapy including intravenous immunoglobulin and plasma exchange, while one patient received only supportive treatment. Autoantibodies against gangliosides, asymmetry of congenital development of blood-nerve barrier and limb use may contribute to the development of asymmetric limb weakness in GBS.
CONCLUSION
Asymmetric GBS may be a rare clinical variant and should be considered when a patient develops acute and progressive asymmetric limb weakness. The differences in clinical features and prognosis between asymmetric GBS and classic GBS deserve further investigation in a large study.
Core Tip: Atypical Guillain-Barré syndrome (GBS) with asymmetric limb weakness was rarely reported, which is easily confusing the diagnosis by clinicians. We herein present three patients diagnosed as GBS who suffered persistent asymmetric limb weakness from onset to recovery phase, two of which received immunotherapy in timely and had a good prognosis. Asymmetric blood-nerve barrier, ganglioside distribution or limb use may cause asymmetric GBS. To differentiate asymmetric GBS is important for an early treatment, which can lead to a good patient outcome and early recovery.
