{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:31:46Z","timestamp":1787758306646,"version":"build-2784847793"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>A 76-year-old male was brought to the emergency room with an acute onset of breathlessness and difficulty swallowing. Examination revealed bilateral ptosis, bilateral vocal cord abductor palsy with diaphragmatic paralysis. He did not have any limb weakness. A diagnosis of acute bulbar palsy was made. Cerebrospinal fluid showed albumino-cytological dissociation. Magnetic resonance imaging of the brain (MRI) was normal, and a nerve conduction study (NCS) showed Acute Motor and Sensory Axonal Neuropathy (AMSAN). Guillain\u2013Barr\u00e9 syndrome with acute bulbar palsy was considered. Here, we report a case of suspected Acute Bulbar Palsy plus (ABPp) syndrome. ABPp may be considered as a variant of GBS between the Miller\u2013fisher and Pharyngeal-cervical-brachial variant and does not have any definite limb weakness. This patient also had ABPp with diaphragmatic palsy. However, whether this syndrome is an isolated variant of GBS or a continuum between the Miller-fisher syndrome (MFS) and Pharyngo-cervical brachial (PCB) variants remains to be elucidated. This case is relevant to primary care physicians as the disability with GBS remains high and may render a large burden to carers. The initial symptom of acute dysphagia must lead on the primary care physician to keep this disease in mind to prevent an unwarranted delay in diagnosis.<\/jats:p>","DOI":"10.4103\/jfmpc.jfmpc_2208_21","type":"journal-article","created":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T06:27:00Z","timestamp":1663050420000},"page":"4854-4856","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Guillain\u2013barr\u00e9 syndrome without limb weakness: A rare variant with acute bulbar palsy"],"prefix":"10.4103","volume":"11","author":[{"given":"Ishan J.","family":"Chavada","sequence":"first","affiliation":[{"name":"Department of Acute Medicine, University Hospitals, Coventry and Warwickshire, United Kingdom CV2 2DX, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siddhant J.","family":"Thampi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinesh","family":"Babu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasanthi","family":"Natarajan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,8,30]]},"reference":[{"key":"B1-20240828","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1159\/000324710","article-title":"Population incidence of Guillain-Barr\u00e9syndrome: A systematic review and 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syndrome: Clinical and immunohistochemical studies","volume":"43","author":"Chiba","year":"1993","journal-title":"Neurology"},{"key":"B5-20240828","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1002\/mus.20835","article-title":"Clinical and immunological spectrum of the Miller Fisher syndrome","volume":"36","author":"Lo","year":"2007","journal-title":"Muscle Nerv"},{"key":"B6-20240828","first-page":"55","article-title":"Acute ophthalmoplegia without ataxia associated with anti-GQ1b antibody in a Chinese Gentleman","volume":"3","author":"Yip","year":"2016","journal-title":"Case Rep Intern Med"},{"key":"B7-20240828","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1001\/archneur.64.10.1519","article-title":"Continuous spectrum of pharyngeal-cervical-brachial variant of Guillain-Barr\u00e9syndrome","volume":"64","author":"Nagashima","year":"2007","journal-title":"Arch Neurol"},{"key":"B8-20240828","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1136\/jnnp-2012-302824","article-title":"Bickerstaff brainstem encephalitis and Fisher syndrome: Anti-GQ1b antibody syndrome","volume":"84","author":"Shahrizaila","year":"2013","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"B9-20240828","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1212\/WNL.0000000000002256","article-title":"Acute bulbar palsy as a variant of Guillain-Barr\u00e9syndrome","volume":"86","author":"Kim","year":"2016","journal-title":"Neurology"},{"key":"B10-20240828","doi-asserted-by":"crossref","first-page":"566480","DOI":"10.3389\/fneur.2020.566480","article-title":"Case Report: Acute bulbar palsy plus syndrome: A Guillain-Barr\u00e9Syndrome variant more prone to be a subtype than overlap of distinct subtypes","volume":"11","author":"Cao","year":"2020","journal-title":"Front Neurol"}],"container-title":["Journal of Family Medicine and Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_2208_21","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:13:16Z","timestamp":1787757196000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_2208_21"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8]]},"references-count":10,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_2208_21","relation":{},"ISSN":["2249-4863","2278-7135"],"issn-type":[{"value":"2249-4863","type":"print"},{"value":"2278-7135","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8]]},"assertion":[{"value":"2021-11-09","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-02-17","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}