Guillain-Barré syndrome presenting as Bell's palsy with crossed hemiparesis.

Dear Editor,

The rare variants of Guillain–Barré syndrome (GBS) are Miller–Fisher and Bickerstaff's brainstem encephalitis, and facial diplegia.[1] GBS can very rarely present as crossed hemiparesis, which occurred in our case. A 45-year-old female presented with left-sided Bell's palsy [Figure 1a] for 1 day with right-sided hemiparesis. The reflexes were diminished bilaterally and plantars were mute. First possibility in this case was a posterior circulation stroke, but her MRI brain ruled out any infarct or hemorrhage. On 2nd day, she developed quadriparesis with facial diplegia [Figure 1b], dysphagia, and bulbar palsy. Now we could make a confident diagnosis of GBS and cerebrospinal fluid (CSF) examination also showed albumino-cytological dissociation (proteins 259 mg/dl and total leukocyte count of 4 cells/mm3). She was treated with intravenous immunoglobulins and a month later she came back walking without support and facial diplegia was also improving [Figure 1c and d]. To conclude, GBS can very rarely present as Bell's palsy with crossed hemiparesis.

Figure 1

(a) Bell's palsy on left side at presentation. (b) Facial diplegia on 2nd day of admission. (c) Patient able to close both eyelids after 1 month. (d) Nasolabial furrow on right side at 1 month, left side is still weak