An Unusual Presentation of the Cervicobrachial Variant of Guillain-Barré Syndrome in a 32-Year-Old Previously Healthy Male.

Guillain-Barré syndrome (GBS) is a rare autoimmune disorder characterized by acute peripheral nerve demyelination. The cervicobrachial (CB) variant presents with predominant upper limb weakness and has distinct clinical features. This case report aims to detail the clinical manifestations, diagnostic methodology, treatment outcomes, and broader implications of the CB variant of GBS. This case report presents a 32-year-old male, with a rare CB type of GBS, characterized by upper limb weakness and distinctive clinical features. Following a recent flu-like illness, the patient exhibited sudden onset weakness and neck pain. Neurological examination revealed proximal muscle weakness in the upper limbs with associated impaired pinprick sensation. Relevant laboratory investigations and imaging supported the diagnosis. The patient was diagnosed based on clinical suspicion, presentation, and cerebrospinal fluid (CSF) albuminocytological dissociation. The patient responded to intravenous immunoglobulin (IVIG) therapy, highlighting the importance of early recognition and intervention. The diagnostic approach involved nerve conduction studies (NCS), CSF analysis, and imaging, with normal findings on CT, MRI brain & cervical spine, and NCS. IVIG therapy resulted in significant improvement in muscle power. In conclusion, this case shows the significance of early recognition and intervention in the CB variant of GBS. The diagnostic methodology, encompassing advanced modalities, played a crucial role in confirming the diagnosis.

Cerebrospinal fluid confirmed COVID-19-associated encephalitis treated successfully.

The COVID-19 pandemic that attracted global attention in December 2019 is well known for its clinical picture that is consistent with respiratory symptoms. Currently, the available medical literature describing the neurological complications of COVID-19 is gradually emerging. We hereby describe a case of a 31-year-old COVID-19-positive patient who was admitted on emergency basis. His clinical presentation was primarily neurological, rather than the COVID-19's classical respiratory manifestations. He presented with acute behavioural changes, severe confusion and drowsiness. The cerebrospinal fluid analysis was consistent with COVID-19 encephalitis, as well as the brain imaging. This experience confirms that neurological manifestations might be expected in COVID-19 infections, despite the absence of significant respiratory symptoms. Whenever certain red flags are raised, physicians who are involved in the management of COVID-19 should promptly consider the possibility of encephalitis. Early recognition of COVID-19 encephalitis and timely management may lead to a better outcome.

Drug resistant neuroleptic malignant syndrome and the role of electroconvulsive therapy.

Neuroleptic malignant syndrome is considered as a rare but potentially fatal complication of neuroleptic medications e.g.,antipsychotics, sedatives and anti emetics. It is characterized by hyperthermia, muscle rigidity, an elevated creatine kinase level and autonomic instability. The syndrome often develops after the start of antipsychotic or a sudden increase in dosage of the neuroleptic medication or in states of dehydration. Treatment is mainly supportive and includes withdrawal of the neuroleptic medication and, possibly, administration of drugs such as dantrolene and bromocriptine. In rare cases where drugs treatment remains ineffective a trial of electroconvulsive therapy is being given. The case presented is a drug resistant case of Neuroleptic Malignant Syndrome where finally electroconvulsive therapy was effective.