P.055 Bilateral facial nerve gadolinium enhancement and GBS

Abstract

Background: Facial diplegia with parasthesia (FDP) is a rare variant of Guillain–Barre syndrome (GBS), and has been reported in less than 1% of GBS cohorts. Here we describe a case of FDP with novel imaging findings and discuss the differential diagnosis. Methods: Case: A 39-year-old man referred to the emergency department with a 2 week history of right facial palsy progressed to bilateral facial palsy. His exam demonstrated severe, complete facial diplegia with only very mild limb weakness and present but diminished deep tendon reflexes. Results: Cerebrospinal fluid analysis showed albuminocytologic dissociation. Electromyography was consistent with a demyelinating process. MRI with contrast revealed bilateral enhancement of the facial nerves in the intracanalicular portion and in the region of the geniculate ganglion. A diagnosis of GBS was made and the patient was treated with IVIG. Over the course of several weeks the patient improved. Conclusions: Although nerve root enhancement of the spinal cord is described with GBS, nerve root enhancement effecting cranial nerves has only rarely been described. In addition, the relative limb-sparing with complete facial paralysis in this case is also an unusual phenotype. The Gadolinium enhancement of the bilateral facial nerves is thought to represent blood brain barrier breakdown due to GBS.