Date Published: August 26, 2008
Publisher: Public Library of Science
Author(s): Rebecca Lim, Sivakumar Sathasivam, Andrew J Larner
Abstract: Andrew Larner and colleagues discuss the differential diagnosis, investigation, and management of a 72-year-old woman presenting with progressive lower limb weakness who develops an acute evolving flaccid quadriparesis.
Partial Text: A 72-year-old woman was admitted with progressive lower limb weakness, such that she was unable to stand or walk. She was previously healthy, accustomed to play tennis twice a week. Five days prior to admission she had developed low back pain radiating to the legs without a history of trauma. The pain was followed by numbness in the legs, beginning distally and then ascending over two or three days. The patient also experienced weakness that became progressively worse, initially making it difficult to climb stairs and then to walk and stand. Although she had no difficulty passing urine, she did complain of impaired sensation of bladder filling. She had noted some difficulty picking up objects with her hands but had no complaint of upper limb numbness or weakness at the time of admission.
GBS has on occasion been reported in association with occult cancer. This might be a chance concurrence of two aetiologically distinct disorders, but might also reflect a paraneoplastic process. In the current classification of paraneoplastic disorders, GBS is regarded as a “non-classic syndrome”, since it is not associated with known onconeural antibodies. The more typical paraneoplastic syndrome of the peripheral nervous system is a subacute sensory neuronopathy, often associated with anti-Hu antibodies . Nonetheless, one study of a large number of cases of typical GBS found the incidence of carcinoma occurring with short latency to be 1.7% . GBS has on occasion been reported in association with pancreatic cancer .