A Case of Guillain-Barre Syndrome Presenting with Bilateral Ptosis

Abstract

Background : Guillain-Barr? syndrome (GBS) is an autoimmune acute peripheral neuropathy, causing limb weakness that progresses over a period of days and up to 4 weeks. Acute bilateral ptosis is caused by various etiologies, but bilateral ptosis without ophthalmoplegia is a very uncommon neurologic manifestation that can be the presenting symptom in a wide range of Guillain-Barre syndrome. We report a rare case of Guillain-Barre syndrome presenting with bilateral ptosis without ophthalmoplegia.

Case : A-27-year old man was hospitalized with bilateral ptosis for 1 day. At admission, neurological examination revealed bilateral ptosis without ophthalmoplegia, but the examination on other cranial nerves was normal. Motor and sensory examinations were normal & deep tendon reflexes were symmetrical and normal. Blood chemistry findings, brain MRI, tensilon test, and repeated stimulation test were normal. Two days after the admission, he developed bilateral facial palsy and distal predominant motor weakness of both lower extremities. Nerve conduction study revealed demyelinating polyneuropathy. Cerebrospinal fluid study showed albumin-cytological dissociation. Gullain-Barre syndrome was diagnosed and he was treated with a 5-day course of IVIG. Bilateral ptosis and motor weakness improved within several weeks after intravenous immunoglobulin therapy.

Conclusion : It has been reported that bilateral ptosis without ophthalmoplegia is a rare finding in typical Guillain-Barre syndrome. Ptosis observed in patients with Guillain-Barre syndrome is usually accompanied with ophthalmoplegia or papillary paralysis. It is very important to diagnose Guillain-Barre syndrome only presenting bilateral ptosis without ophthalmoplegia and motor weakness because early and exact treatment can be done. Therefore, Gullian-Barre syndrome has to be considered in patients presenting bilateral ptosis without other neurological deficits and abnormal findings in tensilon and repeated stimulation tests.