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October 1980

An Uncommon Manifestation of a Common Disease

Arch Intern Med. 1980;140(10):1398. doi:10.1001/archinte.1980.00330210146047

To the Editor.  —Drs Magnussen and Patanella's well-reported case, in the Archives (139:1423-1424, 1979), of bilateral recurrent laryngeal nerve paralysis after herpes simplex virus infection qualifies as an uncommon manifestation of a relatively common neurologic disorder, Guillain-Barré syndrome.Their patient had a rapidly progressive illness associated with weakness, diminished reflexes (areflexia in the lower extremities), cranial nerve involvement, and recovery. Such a constellation of symptoms and signs fulfills the features required for diagnosis, several of the features supportive of the diagnosis, and none of the features that rule out the diagnosis of Guillain-Barré syndrome.1While the patient's elevated CSF protein value, areflexia, and sensory complaints are found in diabetics, they are all equally often found in Guillain-Barré syndrome. A repeated CSF analysis would have differentiated diabetic changes from those typical of polyneuritis. Electrodiagnostic studies, specifically F-wave conduction velocities,2 are useful in evaluating for proximal demyelinative neuropathies.The rising