A Case of Progressive Flaccid Quadriparesis in a Young Woman: Diagnostic Pitfalls and the Role of Backward Reasoning

A 19-year-old woman presented with acute progressive generalized limb weakness and inability to ambulate, after a recent upper respiratory tract infection. Given the flaccid quadriparesis and preceding infection, Guillain-Barré syndrome (GBS) was initially considered. This case aims to illustrate the diagnostic challenges and the critical role of backward reasoning in differentiating GBS mimickers. Neurologic examination, electrodiagnostic studies, brain MRI, and hematologic testing were performed. Motor nerve conduction and late responses were normal, whereas sensory studies indicated pure distal sensory polyneuropathy. MRI revealed cervical spinal cord hyperintensities, and blood tests showed macrocytic anemia and low serum vitamin B12. The diagnosis of severe vitamin B12 deficiency was established. The patient received cobalamin replacement therapy, and significant clinical improvement was observed for a 3-month follow-up period. Vitamin B12 deficiency can mimic GBS, particularly in acute settings. Accurate clinical reasoning, including the application of backward reasoning when atypical findings emerge, is essential to avoid misdiagnosis and ensure timely treatment in patients with acute neurologic presentations.