Clinical Case 1

Alec Small, D.O.

Paul Ehlers, M.D.

Just an average day at work...

CC: Numbness and Tingling

Triage Note: Sent from PCP for numbness & tingling since last saturday ( 1 week). Seen at OSH for same and discharged


38yoM with no medical history presents to the ED for numbness and tingling. Pt states that for about 1 week he has had numbness and tingling throughout his upper and lower extremities. He deny and pain, trauma, urinary or bowel symptoms, chest pain, nausea, vomiting, abdominal pain, fevers, chills. He admits that he is a daily drinker for about 10 years consuming approximately half a pint a day. Recently ceased use 16 days ago. No history of withdraw. Denies vision changes, headaches. States towards end of day he feels weaker and has difficulty using his phone and holding his keys. Says 2 weeks ago he went to his PCP for sore throat which resolved. He has remote history of IV drug use. Denies back pain, hx cancer, steroid use, incontinence/retention, saddle anesthesia.

ROS: Negative except for HPI

Physical Exam

GEN:  Well appearing, NAD

HEENT: NC, AT, MMM, EOMI, Clear conjunctiva, Oropharynx clear

Neck: Supple, no stiffness or restricted ROM

HEART: RRR, Normal S1/2

LUNGS: CTAB, Moving air well, no wheezing

ABD: Soft, nondistended, nontender

BACK: No midline tenderness no obvious deformity

EXTREMITIES: No edema, deformit, DP/radial pulses +2

SKIN: No rashes, warm

NEURO: A&OX4, moves all extremities, CN grossly intact, intention tremor of US, when raising b/l UE shoulders go to his ears, MS 5/5 in b/l UE and LE. Grip strength 5/5, No facial droop, Speaks in clear sentences. Gait…

Click to view gait

Basic Labs

LFTs within normal limits


Let's solve this mystery!

CSF Studies

CSF MS stuff: Negative

CSF Cultures: Negative

MRI: Negative

Click to view diagnosis

Guillian-Barré Syndrome (GBS)

Diagnosis & Treatment

Prognosis & Outcome

Our patient

-Hospitalized for about a week

-Not terribly complicated hospital course

-Follows in outpatient setting regularly

-Living a productive life


van den Berg, B., Walgaard, C., Drenthen, J. et al. Guillain–Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol 10, 469–482 (2014)

Head VA, Wakerley BR. Guillain-Barré syndrome in general practice: clinical features suggestive of early diagnosis. Br J Gen Pract. 2016;66(645):218-219

Noto, A., & Marcolini, E. (2014). Select Topics in Neurocritical Care. Emergency Medicine Clinics of North America, 32(4), 927-938.

Natesan S. Guillain-Barré syndrome - third time's the charm. - Emergency Medicine Education. Published May 22, 2017.