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July 1994

Further Regional Variants of Acute Immune Polyneuropathy: Bifacial Weakness or Sixth Nerve Paresis With Paresthesias, Lumbar Polyradiculopathy, and Ataxia With Pharyngeal-Cervical-Brachial Weakness

Author Affiliations

From the Neurology Service, St Elizabeth's Medical Center, Boston, Mass.

Arch Neurol. 1994;51(7):671-675. doi:10.1001/archneur.1994.00540190051014

Objective:  To describe four syndromes of acute regional weakness with clinical, spinal fluid, and electrophysiologic similarities to the acute immune polyneuropathy of Guillain-Barré syndrome.

Design:  Case series of personally examined patients.

Results:  Seven patients are described: four with facial diplegia and distal limb paresthesias, one with sixth nerve palsy and distal paresthesias, one with bilateral lumbar polyradiculopathy, and one with combined Fisher's syndrome and pharyngeal-cervical-brachial weakness. These self-limited illnesses, which evolved over days or weeks, involved acellular cerebrospinal fluid with raised protein concentration and electrophysiologic findings that were consistent with a demyelinating polyneuropathy.

Conclusions:  The first three regional variants of Guillain-Barré syndrome may cause diagnostic difficulty, particularly at the onset of illness, and the fourth links Fisher's syndrome with the typical syndrome. The consistently bilateral weakness of Guillain-Barré syndrome and its regional variants and the absence of a monoparetic or hemiparetic pattern suggest that the pathologic process occurs in the same single or contiguous groups of nerves on both sides of the sagittal plane but is not randomly distributed in the peripheral nervous system.