Acute multiple cranial neuropathy: a variant of Guillain-Barré syndrome?

Three patients with acute multiple cranial neuropathy following benign infectious disease are reported. Complete or partial ophthalmoplegia, as well as facial and bulbar dysfunction, were noted in all. Cranial nerve involvement was bilateral. Other neurological deficits included sensory loss in two patients and transiently reduced tendon reflexes in the left arm in one. One patient had positive serum anti-GQ1b immunoglobulin G antibody during the acute phase of the illness. The cerebrospinal fluid had a normal cell count in all three patients, with raised protein concentrations in two. Electrophysiological evaluation showed peripheral nerve dysfunction in two patients. All three patients improved either spontaneously or coincident with immunotherapy. Our patients had many clinical features resembling those of typical Guillain-Barré syndrome (GBS), and hence their disorder may represent a regional variant, that is, a cranial form, of GBS. This form of GBS accounted for 5% of the GBS patient population in our series.