Published online Feb 26, 2022. doi: 10.12998/wjcc.v10.i6.1896
Peer-review started: July 20, 2021
First decision: October 16, 2021
Revised: October 27, 2021
Accepted: January 19, 2022
Article in press: January 19, 2022
Published online: February 26, 2022
Processing time: 217 Days and 17.6 Hours
Guillain-Barré syndrome (GBS) is an autoimmune-mediated peripheral neuropathy characterized by symmetric weakness. Asymmetric weakness in GBS is uncommon and may be easily confused with other differential diagnoses. We herein present three cases of asymmetric GBS and review the literature on this atypical subtype of GBS in order to describe the characteristics of asymmetric GBS and to provide experience for clinicians.
Different from patients in the previous reports, our patients showed persistent asymmetric limb weakness from the onset to recovery phase. All three patients were serologically positive for antecedent infections. Two of the three cases had IgG antibodies against ganglioside GM1. Two patients received immunotherapy including intravenous immunoglobulin and plasma exchange, while one patient received only supportive treatment. Autoantibodies against gangliosides, asymmetry of congenital development of blood-nerve barrier and limb use may contribute to the development of asymmetric limb weakness in GBS.
Asymmetric GBS may be a rare clinical variant and should be considered when a patient develops acute and progressive asymmetric limb weakness. The differences in clinical features and prognosis between asymmetric GBS and classic GBS deserve further investigation in a large study.
Core Tip: Atypical Guillain-Barré syndrome (GBS) with asymmetric limb weakness was rarely reported, which is easily confusing the diagnosis by clinicians. We herein present three patients diagnosed as GBS who suffered persistent asymmetric limb weakness from onset to recovery phase, two of which received immunotherapy in timely and had a good prognosis. Asymmetric blood-nerve barrier, ganglioside distribution or limb use may cause asymmetric GBS. To differentiate asymmetric GBS is important for an early treatment, which can lead to a good patient outcome and early recovery.