Complicated neurological pathways: tuberculoma with Guillain-Barre syndrome – an uncharted clinical odyssey

Tuberculosis is a global disease and presents with an array of neurological manifestations. Presentation varies from meningitis, radiculo-myelitis, tuberculoma, brain abscess and other combinations. The association of Guillain-Barre' syndrome (GBS) with tuberculosis has been reported in a few reports. Neurological tuberculosis association with GBS is very rare. We here report an early adolescent patient with tubercular meningitis and tuberculoma who presented with acute areflexic quadriparesis and was subsequently diagnosed as an acute motor sensory axonal neuropathy variant of GBS. The diagnosis was confirmed with clinical examination, nerve conduction studies, positive anti-ganglioside antibody and clinical response to intravenous immunoglobulin. We present a case of an association between tubercular meningitis clinically presenting as encephalopathy and acute flaccid weakness due to GBS.