Differential diagnosis of the pharyngeal-cervical-brachial variant of Guillain-Barré syndrome based on clinical findings
| Pharyngeal-cervical-brachial variant of Guillain-Barré syndrome | Botulism | Myasthenia gravis | Brainstem stroke | |
|---|---|---|---|---|
| Onset | Hours | Hours | Typically with exertion | Seconds to minutes |
| Progression | Gradual | Gradual / descending | Fluctuating / fatiguable | Rapid / stepwise |
| Pattern of weakness | ||||
| Ptosis | + / − | ++ | + / − | + / − |
| Internal ophthalmoplegia | + / − | ++ | − | + / − |
| External ophthalmoplegia | + / − | ++ | + / − | + / − |
| Facial | + / − | ++ | + / − | + / − |
| Bulbar | ++ | ++ | + / − | + / − |
| Arm | ++ | ++ | + / − | + / − |
| Leg | −* | ++ | + / − | + / − |
| Symmetrical | Yes | Yes | Variable | Variable |
| Hypo / areflexia | +** | − | − | − |
| Sensory deficit | + / − | − | − | + / − |
| Other clinical features | Antecedent infectious symptoms | Dry mouth, dizziness, and gastrointestinal symptoms. |
++, present; +/−, sometimes present; −, not present.
*Leg weakness can be mild. **10% of patients have normal or exaggerated reflexes.