Acute relapsing Guillain-Barre syndrome after long asymptomatic intervals
E. F. Wijdicks and A. H. Ropper
Neurological/Neurosurgical Intensive Care Unit, Massachusetts General Hospital, Boston 02114.
Five patients who recovered from an initial episode of Guillain-Barre
syndrome had acute relapses 4, 10, 15, 17, and 36 years later,
respectively. Two patients had multiple subsequent relapses. The antecedent
illnesses, distribution of weakness, and clinical courses of each relapse
were similar for each patient, except that relapses in three patients were
briefer than the initial episode. One patient had asymptomatic sarcoidosis.
Pharyngeal, oculomotor, and diaphragmatic weakness requiring a ventilator
were common. Complete recovery or mild residual deficits, return of
reflexes, normal cerebrospinal fluid protein at the onset of recurrent
episodes, and normal or virtually normal nerve conduction velocities at
various times distinguished these patients from those with more typical
chronic relapsing inflammatory polyneuropathy.
