Preserved tendon reflexes in a clinically suspected sensory-predominant GBS-spectrum disorder: a case report

Guillain–Barré syndrome usually comes to clinical attention because of progressive weakness and reduced or absent tendon reflexes. Some patients, however, present mainly with sensory symptoms and still have preserved reflexes, making early diagnosis more difficult. A 71-year-old Han Chinese man presented with distal paresthesia after an episode of diarrhea, and the symptoms became noticeably worse over the next 2 days. The sensory disturbance spread in a glove-and-sock pattern and was accompanied by heaviness in the legs, difficulty walking, and mild distal weakness. Neurological examination showed reduced distal superficial sensation, preserved tendon reflexes, and no pathological reflexes. Brain MRI showed no clinically relevant abnormality, and spinal MRI showed degenerative changes without a definite central lesion explaining the symptoms. Cerebrospinal fluid showed protein of 590 mg/L with a reported white blood cell count of 0.001 × 10 6 /L, a pattern compatible with albuminocytologic dissociation. Because nerve conduction studies and electromyography were not completed during hospitalization, the diagnosis remained a clinically suspected sensory-predominant disorder within the GBS spectrum rather than electrophysiologically confirmed classic GBS. Clinical notes recorded improvement during hospitalization, and the patient regained independent ambulation after receiving intravenous immunoglobulin alongside supportive and adjunctive therapies. At a telephone follow-up approximately 12 months later, he reported no recurrence; no objective follow-up examination was available. In patients with acute symmetric distal sensory symptoms after a gastrointestinal illness, preserved tendon reflexes do not by themselves exclude a GBS-spectrum disorder. In this patient, the clinical course and cerebrospinal fluid findings supported consideration of that diagnosis, but the absence of electrophysiological testing precluded confirmation. This case emphasizes the diagnostic challenge posed by atypical sensory-predominant presentations and also highlights that, without electrophysiological confirmation, both subtype assignment and overall diagnostic certainty remain constrained.