{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T13:18:07Z","timestamp":1784121487575,"version":"3.55.0"},"reference-count":58,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023]]},"abstract":"<jats:p>We describe the case of a 44-year-old gentleman with hypertension and asthma presenting to the emergency department after noticing right upper-extremity weakness upon awakening. Brain imaging did not reveal a stroke. Initial neurological examination pointed to cervical myelopathy with radiculopathy as well as possible underlying length-dependent peripheral neuropathy as there was right arm strength of 4\/5 and there were brisker (3+) reflexes all over except at the right biceps reflex and both ankle reflexes. Cervical spine magnetic resonance imaging (MRI) showed myelomalacia at the C2 level and an os odontoideum (OO). Os odontoideum is a chronic condition that occurs due to the failure of the center of ossification of the dens to fuse with the body of C2. By the next day after a few hours of sustaining a fall, weakness progressed to quadriparesis, without a sensory level on examination, followed by urinary retention. This situation was attributed to a possible cervical cord contusion due to the fall in the presence of OO, with other possibilities being spinal cord hemorrhage, infarct and transverse myelitis. However, repeat scanning of the cervical spine (MRI) did not reveal any acute cord changes. The initial examination for common causes of peripheral neuropathy did not reveal any findings. Finally, the diagnosis of Guillain\u2013Barr\u00e9 syndrome (GBS) was considered, and treatment was initiated with intravenous immunoglobulin. Cerebrospinal fluid analysis was normal. The diagnosis was confirmed using electromyography. Our patient\u2019s initial presentation of monoparesis and progression in an asymmetric descending manner was unusual for GBS. His initial presentation mimicked a stroke, and the later progression masqueraded as cervical myelopathy secondary to a chronic cervical cord lesion. The presence of a cervical cord lesion (upper motor neuron) concealed the expected areflexia in GBS. The presence of OO on spine imaging, absence of expected areflexia in GBS, and progression to paraparesis after the fall sidetracked the direction of the initial investigation and led to a relative delay in diagnosis. Nonetheless, appraising the diagnostic data in the clinical context led to an appropriate diagnosis. We emphasize the importance of reconciling the available clinical and diagnostic information to reach the correct diagnosis.<\/jats:p>","DOI":"10.5339\/qmj.2023.16","type":"journal-article","created":{"date-parts":[[2023,8,13]],"date-time":"2023-08-13T02:30:32Z","timestamp":1691893832000},"source":"Crossref","is-referenced-by-count":1,"title":["A young man with Guillain\u2013Barr\u00e9 syndrome, with a stroke-like presentation and physical findings suggestive of cervical myelopathy"],"prefix":"10.5339","volume":"2023","author":[{"given":"Maria","family":"Siddiqi","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Neurology Section, Alkhor Hospital, Hamad Medical Corporation, Doha, Qatar E-mail: msiddiqi2@hamad.qa ORCID: http:\/\/orcid.org\/0000-0002-8092-0346"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sundus","family":"Sardar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Ibrahim","family":"Alhatou","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Neurology Section, Alkhor Hospital, Hamad Medical Corporation, Doha, Qatar E-mail: msiddiqi2@hamad.qa ORCID: http:\/\/orcid.org\/0000-0002-8092-0346"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3277","reference":[{"issue":"(6):","key":"CIT0001","series-title":"Arch Neurol","first-page":"893\u20138","article-title":"Anticipating mechanical ventilation in Guillain-Barr\u00e9 syndrome","volume":"58","author":"Lawn\n \nND","year":"2001;"},{"issue":"(1):","key":"CIT0002","series-title":"Crit Care Med","first-page":"278\u201383","article-title":"Early predictors of mechanical ventilation in Guillain-Barr\u00e9 syndrome","volume":"31","author":"Sharshar\n \nT","year":"2003;"},{"issue":"(10):","key":"CIT0003","series-title":"Brain","first-page":"2866\u201377","article-title":"Regional 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pharyngeal-cervical-brachial variant of Guillain-Barr\u00e9 syndrome","volume":"64","author":"Nagashima\n \nT","year":"2007"},{"issue":"(10):","key":"CIT0008","series-title":"Brain","first-page":"2881\u201396","article-title":"Clinicopathological features of acute autonomic and sensory neuropathy","volume":"133","author":"Koike\n \nH","year":"2010"},{"issue":"(4):","key":"CIT0009","series-title":"Muscle Nerve","first-page":"464\u201370","article-title":"Sensory Guillain-Barr\u00e9 syndrome and related disorders: An attempt at systematization","volume":"45","author":"Uncini\n \nA","year":"2012"},{"issue":"(8):","key":"CIT0010","series-title":"Neurology","first-page":"742\u20137","article-title":"Acute bulbar palsy as a variant of Guillain-Barr\u00e9 syndrome","volume":"86","author":"Kim\n \nJK","year":"2016"},{"issue":"(Pt 1):","key":"CIT0011","series-title":"Brain","first-page":"33\u201343","article-title":"Diagnosis of Guillain-Barr\u00e9 syndrome and validation of Brighton 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Past or present?","volume":"151","author":"Visocchi\n \nM","year":"2009"},{"issue":"(Suppl 3):","key":"CIT0020","series-title":"Neurosurgery","first-page":"A22\u201331","article-title":"Os Odontoideum: Etiology and surgical management","volume":"66","author":"Arwin\n \nB","year":"2010"},{"key":"CIT0021","series-title":"Trauma Case Rep","first-page":"46\u201351","article-title":"Post-traumatic os odontoideum - case presentation and literature review","volume":"18:","author":"Klassov\n \nY","year":"2018"},{"issue":"(Suppl 3):","key":"CIT0022","series-title":"Eur Spine J","first-page":"259\u201363","article-title":"Atlantoaxial dislocation and os odontoideum in two identical twins: Perspectives on etiology","volume":"27","author":"Tang\n \nX","year":"2018"},{"issue":"(7):","key":"CIT0023","series-title":"Spine (Phila Pa 1976)","first-page":"706\u201315","article-title":"Os odontoideum with posterior atlantoaxial instability","volume":"16","author":"Shirasaki\n \nN","year":"1991"},{"key":"CIT0024","series-title":"BMJ Case Rep","first-page":"bcr2015210375","article-title":"An unusual presentation of Guillain-Barr\u00e9 syndrome in a young man with bilateral upper extremity weakness","volume":"2015:","author":"McNicholas\n \nN","year":"2015"},{"issue":"(3):","key":"CIT0025","series-title":"Cureus","article-title":"Atypical descending paralysis in miller fisher syndrome: A rare variant of Guillain-Barre syndrome","volume":"12","author":"Rashid\n \nMH","year":"2020"},{"issue":"(3):","key":"CIT0026","series-title":"J Neurol Neurosurg Psychiatry","first-page":"339\u201344","article-title":"Pharyngeal-cervical-brachial variant of Guillain-Barre syndrome","volume":"85","author":"Wakerley\n \nBR","year":"2014"},{"issue":"(18):","key":"CIT0027","series-title":"Neurology","first-page":"1650\u20134","article-title":"Mortality in Guillain-Barr\u00e9 syndrome","volume":"80","author":"van den Berg\n \nB","year":"2013"},{"issue":"(1):","key":"CIT0028","series-title":"Rev Neurol","first-page":"4\u201310","article-title":"Mortalidad asociada al diagnostico de sindrome de Guillain-Barr\u00e9 en adultos ingresados en instituciones del sistema sanitario Mexicano [mortality associated with a diagnosis of Guillain-Barr\u00e9 syndrome in adults of Mexican health institutions]","volume":"58","author":"Dominguez-Moreno\n \nR","year":"2014"},{"issue":"(1):","key":"CIT0029","series-title":"Acta Neurol Scand","first-page":"47\u201353","article-title":"Clinical characteristics of Guillain-Barr\u00e9 syndrome in a tropical country: A Brazilian experience","volume":"125","author":"Dourado\n \nME","year":"2012"},{"issue":"(6):","key":"CIT0001","series-title":"Arch Neurol","first-page":"893\u20138","article-title":"Anticipating mechanical ventilation in Guillain-Barr\u00e9 syndrome","volume":"58","author":"Lawn\n \nND","year":"2001;"},{"issue":"(1):","key":"CIT0002","series-title":"Crit Care Med","first-page":"278\u201383","article-title":"Early predictors of mechanical ventilation in Guillain-Barr\u00e9 syndrome","volume":"31","author":"Sharshar\n \nT","year":"2003;"},{"issue":"(10):","key":"CIT0003","series-title":"Brain","first-page":"2866\u201377","article-title":"Regional variation of Guillain-Barr\u00e9 syndrome","volume":"141","author":"Doets\n \nAY","year":"2018"},{"issue":"(4):","key":"CIT0004","series-title":"Ann Neurol","first-page":"333\u201342","article-title":"Acute motor axonal neuropathy: A frequent cause of acute flaccid paralysis in China","volume":"33","author":"McKhann\n \nGM","year":"1993"},{"issue":"(1):","key":"CIT0005","series-title":"Ann Neurol","first-page":"17\u201328","article-title":"Pathology of the motor-sensory axonal Guillain-Barr\u00e9 syndrome","volume":"39","author":"Griffin\n \nJW","year":"1996"},{"issue":"(Pt 10):","key":"CIT0006","series-title":"Brain","first-page":"2279\u201390","article-title":"Bickerstaff\u2019s brainstem encephalitis: Clinical features of 62 cases and a subgroup associated with Guillain-Barr\u00e9 syndrome","volume":"126","author":"Odaka\n \nM","year":"2003"},{"issue":"(10):","key":"CIT0007","series-title":"Arch Neurol","first-page":"1519\u201323","article-title":"Continuous spectrum of pharyngeal-cervical-brachial variant of Guillain-Barr\u00e9 syndrome","volume":"64","author":"Nagashima\n \nT","year":"2007"},{"issue":"(10):","key":"CIT0008","series-title":"Brain","first-page":"2881\u201396","article-title":"Clinicopathological features of acute autonomic and sensory neuropathy","volume":"133","author":"Koike\n \nH","year":"2010"},{"issue":"(4):","key":"CIT0009","series-title":"Muscle Nerve","first-page":"464\u201370","article-title":"Sensory Guillain-Barr\u00e9 syndrome and related disorders: An attempt at systematization","volume":"45","author":"Uncini\n \nA","year":"2012"},{"issue":"(8):","key":"CIT0010","series-title":"Neurology","first-page":"742\u20137","article-title":"Acute bulbar palsy as a variant of Guillain-Barr\u00e9 syndrome","volume":"86","author":"Kim\n \nJK","year":"2016"},{"issue":"(Pt 1):","key":"CIT0011","series-title":"Brain","first-page":"33\u201343","article-title":"Diagnosis of Guillain-Barr\u00e9 syndrome and validation of Brighton criteria","volume":"137","author":"Fokke\n \nC","year":"2014"},{"issue":"(6):","key":"CIT0012","series-title":"PLoS One","article-title":"Guillain-Barr\u00e9 syndrome, influenza vaccination, and antecedent respiratory and gastrointestinal infections: A case-centered analysis in the vaccine safety datalink, 2009-2011","volume":"8","author":"Greene\n \nSK","year":"2013"},{"issue":"(9):","key":"CIT0013","series-title":"Lancet Infect Dis","first-page":"769\u201376","article-title":"Risk of Guillain-Barr\u00e9 syndrome after seasonal influenza vaccination and influenza health-care encounters: A self-controlled study","volume":"13","author":"Kwong\n \nJC","year":"2013"},{"issue":"(6):","key":"CIT0014","series-title":"BMJ Case Rep","article-title":"Case of Guillain-Barr\u00e9 syndrome following COVID-19 vaccine","volume":"14","author":"Hasan\n \nT","year":"2021"},{"issue":"(11):","key":"CIT0015","series-title":"Neurol Sci","first-page":"4401\u20132","article-title":"Guillain-Barr\u00e9 syndrome following BNT162b2 COVID-19 vaccine","volume":"42","author":"Trimboli\n \nM","year":"2021"},{"issue":"(12):","key":"CIT0016","series-title":"Emerg Infect Dis","first-page":"3175\u20138","article-title":"Guillain-Barr\u00e9 syndrome associated with COVID-19 vaccination","volume":"27","author":"Shao\n \nS-C","year":"2021"},{"key":"CIT0017","series-title":"Ann Med Surg (Lond)","first-page":"102540","article-title":"Post-COVID-19 vaccine Guillain-Barr\u00e9 syndrome; first reported case from Qatar","volume":"67:","author":"Razok\n \nA","year":"2021"},{"issue":"(11):","key":"CIT0018","series-title":"Nat Rev Neurol","first-page":"671\u201383","article-title":"Diagnosis and management of Guillain-Barr\u00e9 syndrome in ten steps","volume":"15","author":"Leonhard\n \nSE","year":"2019"},{"issue":"(10):","key":"CIT0019","series-title":"Acta Neurochir (Wien)","first-page":"1265\u201374","article-title":"Reducible and irreducible os odontoideum in childhood treated with posterior wiring, instrumentation and fusion. Past or present?","volume":"151","author":"Visocchi\n \nM","year":"2009"},{"issue":"(Suppl 3):","key":"CIT0020","series-title":"Neurosurgery","first-page":"A22\u201331","article-title":"Os Odontoideum: Etiology and surgical management","volume":"66","author":"Arwin\n \nB","year":"2010"},{"key":"CIT0021","series-title":"Trauma Case Rep","first-page":"46\u201351","article-title":"Post-traumatic os odontoideum - case presentation and literature review","volume":"18:","author":"Klassov\n \nY","year":"2018"},{"issue":"(Suppl 3):","key":"CIT0022","series-title":"Eur Spine J","first-page":"259\u201363","article-title":"Atlantoaxial dislocation and os odontoideum in two identical twins: Perspectives on etiology","volume":"27","author":"Tang\n \nX","year":"2018"},{"issue":"(7):","key":"CIT0023","series-title":"Spine (Phila Pa 1976)","first-page":"706\u201315","article-title":"Os odontoideum with posterior atlantoaxial instability","volume":"16","author":"Shirasaki\n \nN","year":"1991"},{"key":"CIT0024","series-title":"BMJ Case Rep","first-page":"bcr2015210375","article-title":"An unusual presentation of Guillain-Barr\u00e9 syndrome in a young man with bilateral upper extremity weakness","volume":"2015:","author":"McNicholas\n \nN","year":"2015"},{"issue":"(3):","key":"CIT0025","series-title":"Cureus","article-title":"Atypical descending paralysis in miller fisher syndrome: A rare variant of Guillain-Barre syndrome","volume":"12","author":"Rashid\n \nMH","year":"2020"},{"issue":"(3):","key":"CIT0026","series-title":"J Neurol Neurosurg Psychiatry","first-page":"339\u201344","article-title":"Pharyngeal-cervical-brachial variant of Guillain-Barre syndrome","volume":"85","author":"Wakerley\n \nBR","year":"2014"},{"issue":"(18):","key":"CIT0027","series-title":"Neurology","first-page":"1650\u20134","article-title":"Mortality in Guillain-Barr\u00e9 syndrome","volume":"80","author":"van den Berg\n \nB","year":"2013"},{"issue":"(1):","key":"CIT0028","series-title":"Rev Neurol","first-page":"4\u201310","article-title":"Mortalidad asociada al diagnostico de sindrome de Guillain-Barr\u00e9 en adultos ingresados en instituciones del sistema sanitario Mexicano [mortality associated with a diagnosis of Guillain-Barr\u00e9 syndrome in adults of Mexican health institutions]","volume":"58","author":"Dominguez-Moreno\n \nR","year":"2014"},{"issue":"(1):","key":"CIT0029","series-title":"Acta Neurol Scand","first-page":"47\u201353","article-title":"Clinical characteristics of Guillain-Barr\u00e9 syndrome in a tropical country: A Brazilian experience","volume":"125","author":"Dourado\n \nME","year":"2012"}],"container-title":["Qatar Medical Journal"],"original-title":[],"link":[{"URL":"https:\/\/www.qscience.com\/view\/journals\/qmj\/2023\/3\/article-16.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.qscience.com\/downloadpdf\/journals\/qmj\/2023\/3\/article-16.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.qscience.com\/downloadpdf\/journals\/qmj\/2023\/3\/article-16.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:20:13Z","timestamp":1777310413000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.qscience.com\/view\/journals\/qmj\/2023\/3\/article-16.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023]]},"references-count":58,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.5339\/qmj.2023.16","relation":{},"ISSN":["2227-0426"],"issn-type":[{"value":"2227-0426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023]]}}}