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Spasticity / Movement Disorders

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1328 - Idiopathic Postpartum Seronegative Guillain-Barré Syndrome (GBS) Variant: A Case Study

Friday, February 23, 2024
5:00 PM – 6:30 PM EDT
Case Diagnosis: Idiopathic Postpartum Seronegative Guillain-Barré Syndrome (GBS) Variant

Case Description: A 28-year-old multiparous female presented to the emergency room with worsening lumbar and lower extremity cramps, gait disturbances, and lower extremity weakness which progressively escalated to bilateral hand and facial tremors. Further history revealed that she had developed her symptoms approximately 3-4 weeks ago post-Cesarean delivery during OBGYN care, where her symptoms were initially deemed non-concerning. Physical examination revealed bilateral diminished sensation in her lower extremities, hypertension, and tachycardia. An initial L-spine CT scan showed a likely unrelated L5-S1 disc protrusion. Further laboratory analysis yielded negative results, while subsequent electromyography suggested demyelinating polyneuropathy, indicating GBS. With the suspicion of GBS, the patient received IVIG treatment, was medically stabilized, and was admitted to the acute rehabilitation floor.

Discussions: GBS's association with pregnancy is rare, with an incidence of 1.2–1.9 cases per 100,000 population. Despite its pathophysiology involving molecular mimicry from prior infections, our patient had no relevant history or positive screenings. The condition's key features include rapid ascending polyneuropathy and potentially fatal respiratory failure, emphasizing the urgency of immediate post-diagnosis interventions. However, as our case demonstrates, the scarcity of GBS in pregnant individuals and the ambiguous symptoms of extremity pain, numbness, and weakness—common in post C-section—create challenges for early detection and intervention, resulting in a poorer prognosis. This patient cohort also presents unique rehabilitation challenges, including disruptions to postpartum recovery and maternal-child bonding. While some studies suggest heightened GBS risk in the initial two postpartum weeks, the precise connection remains unclear, necessitating further investigations. Evidently, our patient's GBS variant diagnosis via electromyography suggests the potential advantage of promptly employing the test for similar postpartum cases.

Conclusions: For postpartum patients experiencing extremity pain, numbness, and weakness, considering GBS screenings, such as electromyography, could facilitate timely interventions and improve prognosis.