Multiple cranial nerves involvement as initial presentation of Guillain-Barré syndrome

Guillain-Barré syndrome is an immune-mediated peripheral nerve disease with classical symptoms of progressive ascending bilateral upper and lower limb weakness. Cranial nerves involvement can be part of manifestation of Guillain-Barré syndrome. Case reports on early involvement of multiple cranial nerves in this disease are limited. We hereby describe a 49 year old man who was diagnosed as Guillain-Barré syndrome presenting unusually with facial diplegia and bulbar palsy that preceded lower limbs weakness and paresthesia. The diagnosis was supported with rare neuroimaging findings of bilateral facial nerves enhancement. He recovered well with supportive management.