Unilateral Facial Paralysis With Facial Nerve Enhancement on MRI in a Patient With Guillain-Barré Syndrome: A Case Report

Guillain-Barré syndrome (GBS) represents a spectrum of inflammatory polyradiculoneuropathies. Several variants have been reported with distinct symptom profiles. Cranial nerve involvement is relatively common, but it most often presents as bilateral facial nerve palsy at onset. We describe the case of a 66-year-old man who initially presented with extremity paresthesia that rapidly progressed to leg weakness and hyporeflexia. The diagnosis of GBS was confirmed by cerebrospinal fluid analysis, and he was treated with intravenous immunoglobulin. Following treatment, however, he developed facial hemiplegia, which was associated with facial nerve enhancement on MRI. This case represents one of the few reports of delayed-onset unilateral cranial nerve palsy in GBS, further distinguished by the rare finding of facial nerve enhancement on MRI. Awareness of such uncommon variants is important, as they may influence both morbidity and mortality.