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Antibodies monospecific to one ganglioside are helpful in delineating the antibody–phenotype correlation in Guillain–Barré syndrome (GBS). GD1b antibodies have mainly been associated with a sensory ataxic variant of GBS.
We describe a patient with GBS after CMV infection with antibodies monospecific to ganglioside GD1b. The clinical presentation of this patient extends the spectrum of GD1b-associated phenotypes with asymmetrical weakness in the limbs, unilateral facial palsy, unilateral abducens palsy and respiratory impairment.
A 58-year-old man was referred because of progressive difficulties with walking 3 weeks after a respiratory-tract infection. The neurological deficit progressed over a few days with muscle weakness mainly on the right side of his body, asymmetrical paraesthesias, double vision and a facial palsy. On neurological examination he had a left abducens, a right facial palsy and profound muscle weakness, especially on the right side, with only minor sensory abnormalities. At the peak of symptoms there was weakness (MRC grade 4) of the neck muscles. In the limbs, there was weakness most pronounced on the right side (MRC …