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Bifacial Weakness or Sixth Nerve Paresis With Paresthesias, Lumbar Polyradiculopathy, and Ataxia With Pharyngeal-Cervical-Brachial Weakness

Allan H. Ropper, MD

Arch Neurol. 1994;51(7):671-675.

Abstract
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.

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

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