—we appreciate Dr Smith's thoughtful comments concerning our case report, "Herpes Simplex Virus and Recurrent Laryngeal Nerve Paralysis." The possibility that the patient's cranial nerve paralysis represented an atypical presentation of Guillain-Barré syndrome is interesting. Several aspects of the patient's clinical course were definitely unusual for Guillain-Barré syndrome, including high fever at the onset of the neuritis, asymmetry of the motor weakness, absence of universal areflexia, and rapid recovery of extremity strength (the patient was able to take a few steps three days after admission to the hospital).1 Also, CSF obtained on day 8 of the hospitalization had a normal protein level of 14 mg/dL in contrast to 56 mg/dL on the day of admission. Such a rapid return to normal of the CSF protein value is uncommon in Guillain-Barré syndrome.2
As Dr Smith indicates, there is evidence for an association between herpesvirus infection and Guillain-Barré syndrome.3,4
Magnussen CR, Patanella HP. An Uncommon Manifestation of a Common Disease-Reply. Arch Intern Med. 1980;140(10):1398. doi:10.1001/archinte.1980.00330210146048
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