Several clinical variants of Guillain-Barr'e syndrome(GBS) merit separate description because they simulate othe diseases and because they may illuminate the pathohysiology of the typical illness. Some limited regional forms of the GBS and
unusual
focal
signs or symptoms that resemble other illnesses are described.
A number of patients willhave prominent pharyngeal. Facial, and neck-flexion weakness at the onset of GBS, which descends to involve the arms, and soon after, the legs. The unusual of distribution of weakness, preservation of leg reflexes, and
unusual
absence of paresthesias directs diagnostic attention toward myasthenia, botulism, or diphtheria. In a few such patients the illness halts when it has caused severe oropharyngeal, neck, shoulder, and proximal arm weakness, completely sparing power
and
reflexes in the legs. We report two cases of unusual clinical variant of GBS, so called pharyngeal-cervical-brachial variants who had bilateral ptosis, marked oropharyngeal, neck, and shoulder weakness, and with areflexia in the arms only, and
normal
sensation. Botulism or diphtheria and less so, myasthenia, were initially considered diagnoses. The illness progressed to generalized typical GBS with respiratory failure in one paticnt. In the other patient, the illness halted without affecting
power
or reflexes in the legs, and electrophysiologic abnormalities were isolated to the face and the arms.
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