Unilateral hypoglossal nerve palsy with asymmetric facial and limb paresis in axonal Guillain-Barré syndrome

Abstract

We report a 45-year-old man with motor axonal Guillain-Barré syndrome who developed left facial nerve palsy, right hypoglossal nerve palsy, and predominantly left-sided upper limb paresis and left lower limb paresis. Blood examination identified immunoglobulin G antibodies against gangliosides GD1a, GD1b and GQ1b, and GD1b/GD1a and GD1b/GT1b complexes. He was treated with intravenous immunoglobulin (400 mg/kg/day for 5 days) twice, and tongue deviation and facial palsy resolved in 3 months. Unilateral or asymmetric involvement of the cranial and limb nerves represent a variant form of axonal Guillain-Barré syndrome.