Guillain-Barré syndrome (GBS) is a self-limiting immune-mediated neuropathy, pharyngeal-cervical-brachial (PCB) and paraparetic variants are rare variants of GBS spectrum disorders, and there are no reports of their coexistence. The patient had an episodic course with progressive exacerbation, with frequent episodes of weakness and soreness in both lower limbs as the main complaints, and presented with dysphagia in this occurrence. The patient was diagnosed with a case of GBS presenting features of both PCB and paraparetic variants. The patient was treated with human immunoglobulin and Vitamin B1 and vitamin B12 nutritional neurotherapy. Owing to the clear diagnosis of GBS with features of both PCB and paraparetic variants, the patient received an intravenous infusion of 34 g of human immunoglobulin, which was received for 5 consecutive days during which the above symptoms did not occur. A case of an anti-GT1a antibody-positive GBS variant with episodic onset is reported in this article. Rare and atypical symptoms are easy to misdiagnose clinically, thus the clinical data, diagnosis and treatment were analyzed to improve the understanding of the disease by clinicians.

To understand the demographic characteristics (age, sex and comorbidities), distribution of electrodiagnostic subtypes, and severity and prognosis of Guillain-Barre syndrome (GBS) variants. This 5-year retrospective study was conducted between January 2018 and December 2023. The patients (n = 137) were diagnosed using the NINDS criteria. Severity and prognosis were assessed using the Hughes disability score. Electrodiagnostic variants of GBS were labelled using a nerve conduction study. The patient group showed male predominance with an increased incidence with age. Antecedent infections were observed in 52 (38%) patients. Motor weakness, areflexia, and cranial nerve involvement (VII,IX,X,XI) were the most common clinical manifestations. The electrodiagnostic profiling included 96 (70%) patients with acute demyelinating polyradiculoneuropathy (AIDP), 25 (18.24%) patients of axonal forms and 16 (11%) patients of Bickerstaff Brainstem Encephalitis, Miller Fisher syndrome and paraparetic variants. Albumin cytological dissociation was documented in 61 (70%) patients out of 86 patients, which was more marked in AIDP than in other variants. The severity of GBS, using the Hughes disability score, was higher in patients with underlying diabetes mellitus. Recurrent GBS was observed in three (2%) and mortality rate was 2.91%. Our study showed a higher incidence of demyelination than that of axonal variants. There was more variation in albumin cytological dissociation in demyelinating subtypes than in the other variants. GBS severity was significantly higher in the patients with diabetes mellitus.

Epidural procedures are widely used as an analgesic adjunct in various surgeries, allowing for a reduction in the use of opioids and the avoidance of their side effects. According to the third National Audit Project in the United Kingdom, the incidence of serious complications related to epidural puncture is very low. A case is presented of a 66-year-old woman who underwent surgery for ovarian oncological pathology and developed, as a complication of neuroaxial anaesthesia in the postoperative period, a sensory-motor disorder limited to the lower limbs, compatible with the paraparesis variant of Guillain-Barré syndrome.

 Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis worldwide and can be classified into electrophysiological subtypes and clinical variants.  This study aimed to compare the frequency of the sural-sparing pattern (SSP) in subtypes and variants of GBS.  This retrospective cohort study analyzed clinical and electrophysiological data of 171 patients with GBS hospitalized in public and private hospitals of Natal, Rio Grande do Norte, Brazil, between 1994 and 2018; all cases were followed up by the same neurologist in a reference neurology center. Patients were classified according to electrophysiological subtypes and clinical variants, and the SSP frequency was compared in both categories. The exact Fisher test and Bonferroni correction were used for statistical analysis.  The SSP was present in 53% (57 of 107) of the patients with acute inflammatory demyelinating polyradiculoneuropathy (AIDP), 8% (4 of 48) of the patients with axonal subtypes, and 31% (5 of 16) of the equivocal cases. The SSP frequency in the AIDP was significantly higher than in the axonal subtypes (p < 0.0001); the value was kept high after serial electrophysiological examinations. Only the paraparetic subtype did not present SSP.  The SSP may be present in AIDP and axonal subtypes, including acute motor axonal neuropathy, but it is significantly more present in AIDP. Moreover, the clinical variants reflect a specific pathological process and are correlated to its typical electrophysiological subtype, affecting the SSP frequency.  A síndrome de Guillain-Barré (GBS) é a causa mais comum de paralisia flácida aguda em todo o mundo e pode ser classificada em subtipos eletrofisiológicos e variantes clínicas.  Este estudo teve como objetivo comparar a frequência do padrão de preservação do sural (SSP) em subtipos e variantes de GBS. MéTODOS:  É um estudo de coorte retrospectivo que analisou dados clínicos e eletrofisiológicos de 171 pacientes com GBS internados em hospitais públicos e privados de Natal, Rio Grande do Norte, Brasil, entre 1994 e 2018. Todos os casos foram acompanhados pelo mesmo neurologista em centro de referência em neurologia. Os pacientes foram classificados de acordo com os subtipos eletrofisiológicos e variantes clínicas e a frequência do SSP foi comparada em ambas as categorias. O teste exato de Fisher e a correção de Bonferroni foram utilizados para análise estatística.  O SSP esteve presente em 53% (57 de 107) dos pacientes com polirradiculoneuropatia desmielinizante inflamatória aguda (PDIA), em 8% (4 de 48) dos pacientes com subtipos axonais e em 31% (5 de 16) dos casos não definidos. A frequência do SSP no AIDP foi significativamente maior do que nos subtipos axonais (p < 0,0001); o valor manteve-se elevado após exames eletrofisiológicos seriados. Apenas o subtipo paraparético não apresentou SSP. CONCLUSãO:  O SSP pode estar presente na PDIA e nos subtipos axonais, incluindo a neuropatia axonal motora aguda, mas está significativamente mais presente na PDIA. Além disso, as variantes clínicas refletem um processo patológico específico e estão correlacionadas ao seu subtipo eletrofisiológico típico, afetando a frequência do SSP.

Guillain-Barré syndrome (GBS) is the most common cause of acute neuropathy. It usually onset with a rapidly progressive ascending bilateral weakness with sensory disturbances, and patients may require intensive treatment and close monitoring as about 30% have a respiratory muscle weakness and about 10% have autonomic dysfunction. The diagnosis of GBS is based on clinical history and examination. Complementary examinations are performed to rule out a differential diagnosis and to secondarily confirm the diagnosis. GBS is usually preceded by an infectious event in ≈ 2/3 of cases. Infection leads to an immune response directed against carbohydrate antigens located on the infectious agent and the formation of anti-ganglioside antibodies. By molecular mimicry, these antibodies can target structurally similar carbohydrates found on host's nerves. Their binding results in nerve conduction failure or/and demyelination which can lead to axonal loss. Some anti-ganglioside antibodies are associated with particular variants of GBS: the Miller-Fisher syndrome, facial diplegia and paresthesias, the pharyngo-cervico-brachial variant, the paraparetic variant, and the Bickerstaff brainstem encephalitis. Their semiological differences might be explained by a distinct expression of gangliosides among nerves. The aim of this review is to present pathophysiological aspects and the diagnostic approach of GBS and its variants.