An unusual occurrence of opsoclonus and liver enzymes elevation in a patient with acute motor and sensory axonal neuropathy subtype of Guillain-Barré syndrome

• Published in: BMC neurology 2022-03, Vol.22 (1), p.102-102, Article 102
• Main Authors: Alzuhaily, Hasan, Khashaneh, Eman, Albkhetan, Sanaa, Abbas, Fatima
• Format: Article
• Language: English
• Subjects: Adult; Case Report; Case studies; Complications and side effects; Diagnosis; Eye Movements; Guillain-Barre syndrome; Guillain-Barre Syndrome - complications; Guillain-Barre Syndrome - diagnosis; Guillain-Barré syndrome; Humans; Liver; Liver Disease; Male; Neurologic Examination; Ocular Motility Disorders; Opsoclonus; Opsoclonus myoclonus syndrome; Peripheral Nervous System Diseases; Risk factors
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-022-02599-0

Acute motor and sensory axonal neuropathy (AMSAN) is a subtype of Guillain-Barré syndrome (GBS) differentiated by nerve conduction studies (NCS) and characterized by symmetric ascending paralysis often involving respiratory muscles. While opsoclonus, which is involuntary chaotic rapid eye movements, is not a common manifestation of GBS. Moreover, little published data are available on the relation between liver enzymes elevation and GBS. A 42-year-old man presented to Al Mouwassat University Hospital with weakness in all limbs and dyspnea. Examination showed an elevated respiratory rate, hyporeflexia, and decreased strength of upper and lower limbs. Analysis of cerebrospinal fluid revealed an albuminocyto-dissociation suggesting the diagnosis of GBS and subsequent plasmapheresis. NCS confirmed a diagnosis of AMSAN. Elevation in liver enzymes was noticed prompting further exploration with no positive findings. Despite treatment efforts, the patient developed severe dyspnea, deterioration in cognitive abilities, and opsoclonus with a normal brain MRI. Unfortunately, he developed respiratory failure which lead to his death. In this case, we highlight the occurrence of opsoclonus which is a rarely-encountered manifestation of GBS, in addition to an unexplained elevated liver enzyme, the thing that could contribute to larger research to further comprehend the pathophysiology of GBS.