Stroke at Sea? A Case of Guillain-Barré Syndrome Initially diagnosed as a Cerebrovascular Event

Case Diagnosis: Guillan-Barré Syndrome (GBS), Miller Fisher Variant

Case Description or Program Description: A previously ambulatory and active 68-year-old male presented with sensory disturbances and difficulty walking while on a cruise, which advanced to ascending weakness, areflexia, paresthesias, ophthalmoplegia and facial asymmetry. Patient reported having a respiratory infection 10 days prior to symptom onset. Initially suspected of having an acute cerebrovascular accident (CVA).

Setting: Inpatient hospital

Assessment/Results: The patient was admitted with a head CT showing no evidence of an acute CVA. However, lumbar puncture and electromyography findings were consistent with Acute Inflammatory Demyelinating Polyneuropathy. After receiving intravenous immunoglobulin (IVIG) in the intensive care unit, he was transferred to an inpatient rehabilitation facility. During hospitalization, he developed complications associated to GBS such as hyponatremia, dysautonomia, and severe neuropathic pain. His clinical course followed the typical GBS trajectory, with worsening symptoms followed by gradual improvement. Despite severe symptoms, he demonstrated measurable functional recovery after inpatient rehabilitation.

Discussion (relevance): This case highlights the insidious progression of GBS and importance of early detection of worsening symptoms. The clinical trajectory and associated complications can also provide valuable insight into prognosis and help set realistic expectations for both the patient and their family.

Conclusions: This patient's presentation was consistent with the Miller Fisher variant of GBS. While his functional prognosis remained guarded, inpatient rehabilitation facilitated significant progress, reinforcing its critical role in maximizing recovery.