Bilateral Lower Motor Neuron Facial Palsy in a Mild AIDP Variant of Guillain–Barré Syndrome: A Case Report

Abstract

Introduction: Guillain–Barré Syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy characterized by rapidly progressive weakness, areflexia, and variable sensory disturbances. Although cranial nerve involvement occurs in a subset of patients, bilateral lower motor neuron (LMN) facial palsy as a prominent feature is considered an uncommon variant. Early recognition and appropriate monitoring are essential to prevent respiratory or autonomic complications.

Case Presentation: A 37-year-old woman presented with a 16-day history of progressive paresthesia in the extremities accompanied by bilateral LMN facial palsy and mild lower limb weakness. Neurological evaluation showed decreased deep tendon reflexes, glove-stocking sensory disturbance, and preserved respiratory function. Cerebrospinal fluid analysis revealed albuminocytologic dissociation, and electrophysiological studies demonstrated demyelinating motor polyradiculoneuropathy consistent with the acute inflammatory demyelinating polyneuropathy (AIDP) variant of GBS. The patient showed continuous clinical improvement with supportive management, without requiring immunotherapy.

Discussion: This case represents an uncommon cranial-nerve–predominant form of GBS in which bilateral facial palsy appeared as the dominant manifestation despite mild limb involvement. The patient’s favorable clinical trajectory, along with improving motor and sensory deficits, aligns with literature indicating that mild AIDP cases may recover well with conservative therapy alone. This highlights the importance of individualized assessment, as immunotherapy may be unnecessary in patients who remain ambulatory and exhibit early spontaneous improvement.