Guillain Barré syndrome (GBS) is an advanced symmetrical limb weakness, in which profound tendon reflexes disappear. The disease is categorised by a severe onset and the clinical symptoms often reach their peak at the 4th week. GBS is established as multiple nerve root and peripheral nerve injury, often with protein cell separation in the cerebrospinal fluid. It often presents a single phase selflimiting course; intravenous immunoglobulin and plasma exchange therapy are effective for the treatment of GBS. Demyelination is the foremost electrophysiological and pathological feature of this disease. In the past 20 years, it has been documented that there are widespread subtypes of the condition, which comprise acute inflammatory demyelinating polyneuropathy, acute motor axonal neuropathy, acute motorsensory axonal neuropathy, Miller Fisher syndrome, acute autonomic neuropathy and acute sensory neuropathy. Certain patients with sensory neuropathy might actually exhibit sensory GBS. However, case reports are rare. We are presenting a case of sensory GBS treatment in the study.

Case report

A 19 year old, female patient presented to us with six days history of tingling sensations in all the four limbs, tremulousness in both upper limb and imbalance while walking with swaying to either directions. Patient had history of loose stools ten days before the onset of above symptoms for which she had taken some local treatment. There is no history of neck pain, neck trauma, bowel bladder involvement, limb weakness, visual disturbance, slurring of speech, nausea, vomiting.

Sensory examination revealed impaired fine touch, vibration and joint position upto bilateral wrist and knee joint with normal pain and temperature sensations. Gait was sensory ataxic type with positive romberg test. Routine blood investigations including vitamin B12 and retroviral test was normal. MRI brain with cervical screening was normal. CSF examination showed normal cell count, glucose level with mildly raised protein level (93mg/dl). Nerve conduction study showed sensory motor axonal affection of left peroneal nerve with sensory axonal affection of right median, right ulnar and both sural nerves. Based on above findings, diagnosis of sensory ataxic variant of guillain barre syndrome was made. Intravenous immunoglobulins was started at 2mg/kg body weight after which the disease progression stopped from third day and patient started improving after five days treatment. Patient was discharged after eight days and she improved completely after two weeks of follow up.

Discussion

In the present case, the clinical manifestations in the patient were sensory disturbance and imbalance. Certain patients may exhibit subjective weak limb muscle strength, and electrophysiology tests can show demyelination of the involved motor fiber, which is also considered as a lesion in the large sensory fiber. Patients who showed only clinical sensory neuropathy, and who were indicated to have motor and sensory fiber demyelination by  lectrophysiological examination, or demyelination only involving the sensory fibers, could be diagnosed with sensory type GBS.