An Atypical Presentation of Guillain-Barré Syndrome: Bilateral Facial Nerve Palsy With Preserved Reflexes

Guillain-Barré syndrome (GBS) classically presents with ascending weakness and areflexia, but atypical variants can pose diagnostic challenges. Bilateral facial diplegia with paresthesia represents a rare localized variant, and the presence of preserved reflexes further deviates from typical presentations. This case highlights an unusual presentation of GBS characterized by bilateral facial nerve palsy with preserved deep tendon reflexes. We present here the case of a 29-year-old woman who presented with bilateral facial numbness and distal limb paresthesia one week after symptom onset and three weeks following Tdap (tetanus, diphtheria, acellular pertussis) vaccination. This case emphasizes that clinicians should maintain a high index of suspicion for GBS in patients presenting with bilateral facial palsy and paresthesia, even when classic areflexia is absent, as early recognition and immunotherapy can significantly improve outcomes.