Abstract 077: Bilateral medial medullary infarction mimicking Guillain‐Barré Syndrome (GBS): Case report and qualitative systematic review

Purpose To summarize the medical literature related to the diagnosis of bilateral medial medullary infarction (MMI) mimicking GBS. Methods We identified all published case studies in five databases until February 2024. We performed a narrative synthesis to develop differential criteria on the included cases. A case report is also presented. Results We present the case of a patient with asymmetric and progressive motor weakness, bulbar dysfunction, albuminocytologic dissociation in cerebrospinal fluid (CSF), and negative brain CT scan in the acute stage. He was initially diagnosed with Guillain‐Barré Syndrome (GBS), treated with immunoglobulin without a favorable response, finally the diagnosis of MMI was made with re‐evaluation during the evolution and confirmed by brain magnetic resonance imaging. A systematic review of the literature of MMI case reports was carried out, focusing on an initial diagnosis of Guillain‐Barré Syndrome. We selected 8 studies (9 patients) of bilateral MMI with problems in the timely diagnosis and initial diagnosis of GBS. The most frequent clinical onset was respiratory problems (44.4%). The finding in CSF and nerve conduction studies were normal or negative in 60% of the cases. The delay occurred in the early stages of diagnosis in all cases. The use of immunosuppressive therapy was given in only one case. A discussion of the case report and the diagnostic challenges reported in the literature was made. Conclusion It is recommended to consider MMI for differential diagnosis in patients with symptoms of acute progressive quadriparesis and bulbar dysfunction, therefore a thorough assessment of the clinical presentation is necessary.