GUILLAIN -BARRÉ SYNDROME WITH BULBAR DISORDERS, ATAXIA AND HYPERSOMNIA AT THE ONSET OF THE DISEASE

Abstract

Bulbar disorders in Guillain-Barre syndrome (GBS) are observed in approximately a third of patients [1], however, at the very beginning of this disease they occur rarely, mainly in such atypical variants as the pharyngo-cervico-brachial form, M. Fisher syndrome and brainstem encephalitis Bickerstaff [2–5]. In 2016, JK Kim et al . proposed to identify an independent atypical variant of GBS, which they designated as “acute bulbar palsy plus” (ABPP) [6]. Its distinctive feature is the acute development of pronounced bulbar syndrome at the onset of the disease in the absence of motor deficits in the extremities. This form of GBS always creates diagnostic difficulties, since it requires differentiation with another pathology, the early manifestations of which may be acute/subacute bulbar disorders (brain stroke, encephalitis, myasthenia gravis, botulism, etc.). Under our supervision was patient N., 55 years old, a gas station operator, who was hospitalized at the Nizhny Novgorod Regional Vascular Center (RSC) with suspected stroke. 2 weeks before hospitalization, the patient suffered an acute respiratory infection complicated by bronchitis. She received outpatient treatment at her place of residence (took antibiotics).