466 - 18-year -old female diagnosed with Acute Bulbar Palsy Plus Syndrome A variant of Guillain Barre Syndrome: A Case Report

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

TM

Timithy M. McClellan, DO

Resident Physician
Tower Health. Physical Medicine. and Rehabilitation
Reading, Pennsylvania, United States

Corresponding Author(s)

EC

Ellie Clawson, BS

Medical Student
Drexel University College of Medicine
Wyomissing, Pennsylvania, United States

Case Diagnosis: Acute Bulbar Palsy Plus Syndrome

Case Description: An 18-year old female with iron deficiency anemia presented to the hospital with 2 days of facial numbness and weakness and 2 weeks of paresthesias of the hands and feet following a diarrheal illness. Examination was remarkable for subjective facial numbness, bilateral facial weakness worse on the left, dysarthria, proximal lower extremity weakness, diminished lower extremity reflexes, ataxia, and positive Romberg. MRI brain showed enhancement of CN V3 and VII. MRI Lumbar spine showed homogenous enhancement of cauda equina. CSF studies were consistent with albuminocytological dissociation, with negative cultures and enterovirus PCR. Based on clinical evidence, the patient was diagnosed with Acute Bulbar Palsy Plus Syndrome (ABPPS), a variant of Guillain Barre Syndrome (GBS). She completed 5 days of IVIG and was transferred to inpatient rehabilitation. During her rehab course, she developed worsening leg weakness and was transferred back to acute care hospital for another 5 days of plasmapheresis.

Discussions: A variant of GBS, Acute Bulbar Palsy Plus Syndrome is a rare disorder characterized by common symptoms of GBS plus acute bulbar palsy, which is typically the presenting symptom. Other symptoms include ataxia, additional cranial nerve involvement, and lack of neck weakness. Anti-ganglioside antibodies may be positive. Treatment is with IVIg, plasmapheresis for 5 days, and/or IV steroids. Patients will typically require acute inpatient rehabilitation. Complete recovery typically occurs within one year. In this case, the patient required an additional 5 days of plasmapheresis before noting significant improvement in symptoms.

Conclusions: In a patient with facial numbness and weakness, it is important to take a thorough history that inquires about other neurological symptoms and potential triggers for GBS and ABPPS. First-line treatment for ABPPS tis plasmapheresis or IVIg followed by rehab.