Early Sensory-Predominant Guillain-Barré Syndrome With Normal Cerebrospinal Fluid and MRI Findings: A Diagnostic Challenge

Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyneuropathy that classically presents with progressive, symmetric weakness and areflexia following a preceding infection. However, early or atypical presentations may lack the hallmark diagnostic features, such as elevated cerebrospinal fluid (CSF) protein or abnormal magnetic resonance imaging (MRI) findings, creating a diagnostic challenge. We present the case of a 46-year-old woman who developed progressive distal paresthesias, gait instability, perioral numbness, hoarseness, and later right foot-drop following a viral-like illness. Initial evaluation revealed normal CSF protein levels, an unremarkable MRI of the brain and spine, and preserved strength, leading to diagnostic uncertainty. Despite these findings, the clinical pattern raised suspicion for early sensory-predominant GBS, and intravenous immunoglobulin therapy was initiated with subsequent clinical improvement. This case underscores the importance of maintaining high clinical suspicion for GBS in patients with compatible symptoms, even in the absence of classical diagnostic findings, to ensure timely intervention and prevent progression.