Rezidivierende asymmetrische Paresen bei einem 52-jährigen Mann

We report a case of a 52 year old male amateur runner with the third relapse of an asymmetric, predominantly motor weakness with some sensory involvement. During the first episode the patient exhibited a sensorimotor deficit of his left arm and leg followed by similar symptoms on the right side. The second episode 2 years later consisted of similar motor symptoms and double vision, both episodes were diagnosed as Guillian-Barre-Syndrome. A nerve biopsy showed a chronic demyelinating neuropathy. Because of an incomplete recovery no athletic running was possible anymore. Due to increased gait ataxia and falls the patient was admitted again. Nerve conduction velocities were normal, but multifocal conduction blocks were demonstrated with proximal high-voltage-stimulation. In addition to slight clinical signs of spasticity of the legs transcranial and spinal magnetic stimulation revealed prolonged central motor conduction times to all limbs the somatosensory evoked potentials showed prolonged latencies, both indicating an involvement of the central nervous system. An electromyography study showed neurogenic lesions in all examined muscles. The GM-1-antibody-titer was positive, the spinal fluid findings were normal. The clinical and electrophysiological differential diagnosis of this case will be discussed including an overview over the literature and the response of our patient to different immune-therapies and follow up data over 18 months will be reported.