An Acute Pharyngeal-Cervical-Brachial Variant of Guillain-Barre Syndrome Manifesting as Isolated Bulbar Palsy

Guillain Barre Syndrome (GBS) is characterised by acute onset ascending quadriparesis with areflexia. One of its rare variants is the Pharyngeal-Cervical-Brachial (PCB) variant which is characterised by acute weakness of the oropharyngeal, neck, and shoulder muscles with swallowing dysfunction. Here, the authors report a case of 57-year-old female, who presented with sudden onset dysphagia and nasal voice without having any limb weakness. Examination revealed reduced reflexes and weak palatal and pharyngeal muscles. Cerebrospinal Fluid (CSF) examination showed an albumino-cytological dissociation and nerve conduction studies revealed demyelinating motor polyneuropathy. A test for anti-GT1a antibody was positive. These findings were consistent with GBS. However, the patient presented only with bulbar involvement which is likely to be the milder form of the rare PCB variant. The patient recovered with plasmapheresis and was discharged in around three weeks. We conclude that GBS should be considered as differential diagnosis in a patient with isolated bulbar palsy.