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Muscle Nerve. 2016 May;53(5):818-22. doi: 10.1002/mus.25028. Epub 2016 Mar 15.

Bifacial weakness with paresthesias: Serial nerve conduction studies indicate diffuse demyelinating neuropathy.

Author information

1
Department of Neurology, Gloucester Royal Hospital, Gloucester, GL1 3NN, UK.
2
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.

Abstract

INTRODUCTION:

Bifacial weakness with paresthesias is a rare subtype of Guillain-Barré syndrome (GBS), characterized by facial diplegia in the absence of any other cranial neuropathies, limb weakness, or ataxia. Frequently, patients also complain of distal limb paresthesias before or at the time they develop facial weakness.

METHODS:

We describe a man who developed post-infective isolated symmetric facial diplegia associated with distal paresthesias. Nerve conduction studies were conducted at 4 time-points over 6 months.

RESULTS:

A monophasic disease course and presence of cerebrospinal fluid albuminocytological dissociation supported a diagnosis of bifacial weakness with paresthesias. Serial nerve conduction studies demonstrated an evolving demyelinating neuropathy with evidence of distal and proximal demyelination without conduction block, which partially resolved over time. Despite complete resolution of facial weakness within weeks, distal paresthesias persisted beyond 6 months.

CONCLUSIONS:

This study suggests that neuropathy in patients with bifacial weakness and paresthesias is demyelinating and diffuse.

KEYWORDS:

Guillain-Barré syndrome; Miller Fisher syndrome; bifacial weakness; facial diplegia; paresthesias

PMID:
26790030
DOI:
10.1002/mus.25028
[Indexed for MEDLINE]

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