GQ1b-Positive Pharyngeal-Cervical-Brachial Variant of Guillain-Barré Syndrome Presenting With Pseudoathetosis and Pseudodystonia in a 47-Year-Old Filipino Female: A Case Report

Guillain-Barré syndrome (GBS) is the most common cause of acute ascending symmetrical paralysis in clinical practice. One of its regional variants is the pharyngeal-cervical-brachial (PCB) variant associated with antibodies against GT1a and GQ1b ganglioside. Pseudoathetosis and pseudodystonia have not yet been reported in this variant. In this study, we report a case of a 47-year-old Filipino female who developed rapidly progressive dysarthria, bibrachial paralysis, and ascending dysesthesias, with pseudoathetosis, or abnormal writhing movements of the extremities, and pseudodystonia, or abnormal postures. Cerebrospinal fluid analysis demonstrated albuminocytologic dissociation, and electrodiagnostic (EDX) studies showed evidence of proximal nerve involvement with predominant late response abnormalities consistent with a demyelinating neuropathy. Ganglioside antibody testing revealed seropositivity for anti-GQ1b. She was given a five-day course of intravenous immunoglobulin (total of 2 grams per kilogram) and underwent physical, speech, and occupational therapy. She was discharged with residual neurologic deficits rendering her bed-bound and assisted for activities of daily living. Two months after treatment, clinical outcome in our patient after intravenous immunoglobulin and regular physical rehabilitation showed complete recovery without any neurologic sequelae.