Objective: To report the unusual occurrence of Guillain-Barre syndrome (GBS) in a case of hereditary spastic paraparesis (HSP) and describe its effect on the preexisting clinical picture as well as the importance of early recognition and treatment.
Clinical presentation and intervention: A 41-year-old man known to have HSP developed an acute and rapid deterioration of muscle power associated with paresthesia in both upper and lower limbs. Clinical examination revealed flaccid quadriparesis with areflexia. Nerve conduction studies were suggestive of demyelinating polyneuropathy and CSF analysis showed increased protein but no cells. The diagnosis of GBS was made in addition to HSP. The patient received intravenous immunoglobulins 20 mg/kg body weight/day for 5 days. He responded very well to the treatment clinically and neurophysiologically and thereafter, he reverted to the preexisting spastic picture of HSP.
Conclusion: The peripheral demyelination with GBS was severe enough to obscure the preexisting clinical picture, but fortunately it responded very well to treatment. The clinical associations with HSP are widely variable, therefore it is very important to recognize acquired treatable causes of weakness in such patients in order to prevent an increase in disability.