Guillain-Barré syndrome with overlap between the finger drop variant and acute bulbar palsy: a case report

Abstract Background Guillain-Barré syndrome (GBS) encompasses diverse variants, and the overlap between these variants often makes the diagnosis of GBS difficult. We report a case of GBS overlapping with both the finger drop variant and acute bulbar palsy. Case presentation: An 81-year-old man presented with dysarthria, dysphagia, and upper limb weakness. The patient exhibited impaired tongue protrusion and the finger drop sign, whereas other cranial nerve functions, leg strength, touch sensation, and proprioception were normal. Brachioradialis and triceps reflexes were diminished. Cerebrospinal fluid analysis revealed elevated protein levels with normal cell counts. Nerve conduction studies showed reduced amplitudes and decreased velocities in the median and ulnar nerves. As GBS was suspected, we initiated intravenous immunoglobulin treatment, resulting in gradual improvement within 3 weeks. Serum IgG antibodies to gangliosides tested positive for GM1, asialo-GM1, GT1a, GD1b, and GQ1b. On the basis of the monophasic disease course and anti-ganglioside antibodies, we confirmed the diagnosis of GBS. Conclusion This case is the first reported instance of an overlap between the finger drop variant and acute bulbar palsy in GBS, highlighting the importance of considering GBS when patients present with a combination of atypical symptoms. Anti-ganglioside antibodies may assist in distinguishing these complex symptoms.