Double Trouble - Guillain-Barré Syndrome (GBS) Presenting as Overlapping Miller Fisher Syndrome (MFS) and Pharyngeal-Cervical-Brachial (PCB) Variant

Sep 28, 2026

Guillain-Barré Syndrome (GBS) is a leading cause of acute flaccid paralysis, but atypical variants such as Miller Fisher Syndrome (MFS) and the Pharyngeal-Cervical-Brachial (PCB) variant may be under-recognized. The report documents a rare case of a 45-year-old previously healthy woman who developed progressive ophthalmoplegia, bulbar weakness, neck flexor weakness, and proximal upper limb weakness after a mild upper respiratory infection. Albuminocytologic dissociation and demyelinating sensorimotor polyneuropathy supported diagnosis, with anti-GQ1b and anti-GT1a IgG antibodies indicating immune mediation; treatment with intravenous immunoglobulin led to complete recovery at three months.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

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Abstract

Introduction

Epidemiology and immune-mediated triggers

Typical and atypical GBS variants

Case Presentation

Clinical presentation and emergency assessment

Review began 11/04/2025 Review ended 11/16/2025 Published 12/03/2025 © Copyright 2025 Kumar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98367 Open Access Case Report Double Trouble: Guillain-Barré Syndrome (GBS) Presenting as Overlapping Miller Fisher Syndrome (MFS) and Pharyngeal-CervicalBrachial (PCB) Variant Amit Kumar 1 , Sandeep Garg 2, Praveen Bharti 3, Bhvika Zutshi 1 1. General Medicine, Maulana Azad Medical College, New Delhi, IND 2. Medicine, Maulana Azad Medical College/Lok Nayak Hospital, New Delhi, IND 3. Medicine, Maulana Azad Medical College, New Delhi, IND Corresponding author: Amit Kumar, [009amitkumar3@gmail.com](009amitkumar3@gmail.com) Abstract Guillain-Barré Syndrome (GBS) is the leading cause of acute flaccid paralysis in India following the decline of poliomyelitis. Classical GBS typically presents with ascending symmetrical weakness and areflexia, while atypical variants, such as Miller Fisher Syndrome (MFS) and the Pharyngeal-Cervical-Brachial (PCB) variant, show distinct clinical patterns that are often under-recognized, particularly in resource-limited settings. This report describes a rare case of a 45-year-old previously healthy woman who developed progressive ophthalmoplegia, bulbar weakness, neck flexor weakness, and proximal upper limb weakness, along with areflexia, following a mild upper respiratory tract infection. Sensory function and lower limb motor strength remained intact. The differential diagnoses included brainstem stroke, myasthenia gravis, and diphtheritic polyneuropathy. Cerebrospinal fluid analysis revealed albuminocytologic dissociation, and nerve conduction studies showed a demyelinating sensorimotor polyneuropathy predominantly affecting the upper limbs. The presence of anti-GQ1b and anti-GT1a IgG antibodies supported an immune-mediated process. A diagnosis of GBS with overlapping MFS and PCB variants was established. The patient received a five-day course of intravenous immunoglobulin along with supportive management. Her neurological function gradually improved, with complete recovery noted at the three-month follow-up. This case highlights the importance of early recognition of overlapping GBS variants, especially in patients with cranial nerve and upper limb involvement. Greater clinical awareness and improved access to ganglioside antibody testing may facilitate earlier diagnosis and better outcomes. The coexistence of MFS and PCB variants also reinforces the concept of GBS as a spectrum disorder with shared underlying mechanisms. Categories: Neurology, Internal Medicine Keywords: acute flaccid paralysis, anti-gq1b antibody, guillain-barré syndrome, miller fisher syndrome, pharyngealcervical-brachial variant Introduction Guillain-Barré Syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy and is now the leading global cause of acute flaccid paralysis following the decline of poliomyelitis. In India, GBS has become a notable neurological emergency, with an estimated annual incidence of 1.5-2.7 per 100,000 population, though this is likely underestimated due to limited diagnostic access in rural regions [1,2] . Infectious triggers, such as Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus, and Mycoplasma pneumoniae, commonly precede the illness and initiate an autoimmune response through molecular mimicry [3] . GBS usually presents with ascending symmetrical weakness, areflexia, and varying degrees of sensory or autonomic dysfunction. Typical variants include acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), and acute motor-sensory axonal neuropathy (AMSAN) . Atypical variants, however, have been increasingly recognized, particularly in Asia. A

FAQs

What clinical pattern did the patient develop in this case of GBS overlap?

She developed progressive ophthalmoplegia, bulbar weakness, neck flexor weakness, and proximal upper limb weakness after a mild upper respiratory tract infection. Sensory function and lower limb motor strength remained intact, with areflexia present.

How was the diagnosis supported in the report?

Cerebrospinal fluid showed albuminocytologic dissociation, and nerve conduction studies demonstrated demyelinating sensorimotor polyneuropathy predominantly in the upper limbs. Anti-GQ1b and anti-GT1a IgG antibodies supported an immune-mediated process, leading to a diagnosis of GBS with overlapping MFS and PCB variants.

What treatment was given and what was the outcome?

The patient received a five-day course of intravenous immunoglobulin with supportive management. Neurological function gradually improved, with complete recovery reported at the three-month follow-up.

Sep 28, 2026

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