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Pyramidal tract involvement in Guillain–Barré syndrome associated with anti-GM1 antibody
  1. M Tomita1,
  2. H Watanabe1,
  3. S Morozumi1,
  4. Y Kawagashira1,
  5. M Iijima1,
  6. T Nakamura1,
  7. M Katsuno1,
  8. H Koike1,
  9. N Hattori1,
  10. M Hirayama1,
  11. S Kusunoki2,
  12. G Sobue1
  1. 1Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
  2. 2Department of Neurology, Kinki University School of Medicine, Osaka, Japan
  1. Correspondence to Professor Gen Sobue, Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; sobueg{at}med.nagoya-u.ac.jp

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Guillain–Barré syndrome (GBS) is a disorder of the peripheral nervous system generally characterised by acute muscle weakness and areflexia.1 Several reports have described that some patients with GBS show hyper-reflexia and a prolongation of the central motor conduction time (CMCT) in the acute or early recovery phase, and most of these cases are acute motor axonal neuropathy (AMAN) associated with anti-GM1 antibody.2 3 However, the mechanisms responsible for the hyper-reflexia and prolongation of the CMCT are still controversial. Here, we report a case of acute motor neuropathy with anti-GM1 antibody characterised by coincidental pyramidal tract involvement supported by the presence of the Babinski sign and a significant prolongation of the CMCT.

Case report

A 59-year-old woman developed progressive weakness in her legs and subsequently in her arms. During the next 2 days, she had increased difficulty with her gait. She was admitted to our hospital on day 3 of the onset of the neurological symptoms. She did not have any symptoms of a precedent infection. A general physical examination was unremarkable. Neurological examination disclosed no impairment of consciousness. Although slight bilateral facial weakness was present, other cranial nerves were intact. Severe muscle weakness was present in the neck and the proximal portion of the bilateral lower extremities. Muscle weakness in the upper extremities and the distal portion of the lower extremities …

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