Dysphagia as initial manifestation of Guillan-Barrè Syndrome in a child

Abstract

The occurrence of dysphagia in a child may be a sign of various pathological conditions and mainly gastrointestinal disorders; neurological causes are not very frequent, but they should be taken in to considerations. Etiological diagnosis is important for minimizing related complications. Here we report the case of a 6-year-old girl who was admitted to our Clinic with sudden onset weakness of the limbs and dysphagia. Physical examination revealed hypo-areflexia of both legs and arms and multiple cranial nerve dysfunction. Based on typical clinical course, laboratory investigations and electrophysiological studies, a diagnosis of Guillain-Barrè Syndrome (GBS) was assessed. A treatment with intravenous immunoglobulin (IVIG) was immediately started with a progressive recovery of motility and cranial nerve function. An electrophysiological evaluation, performed one month after therapy start, showed slight improvement of neurological symptoms, in particular of the sensitive component. On the basis of our experience we suggest that a GBS should be suspected when dysphagia is associated with pain and ascending flaccid paralysis of the limbs, in order to prevent a severe complications such as respiratory failure.

Keywords

• dysphagia
• Guillain-Barrè syndrome
• flaccid paralysis