Isolated unilateral lower motor neuron facial palsy as the presenting feature of Guillain Barre Syndrome in a child

Case report An 11 year old girl presented with inability to close the left eye and water drooling from left corner of the mouth while drinking for one day. There was no history of preceding illness or trauma. Examination revealed isolated lower motor neuron type left facial nerve palsy grade V according to the HouseBrackmann grading system. The rest of the neurological examination was normal with intact sensation. She was treated with oral acyclovir and prednisolone and was referred for physiotherapy. On day 3 of the illness, she developed difficulty in getting up from the squatting position. Examination revealed bilateral weakness of lower limbs (Grade 3) with absent ankle jerks along with the left sided lower motor neuron facial nerve palsy noted three days back. No sensory deficits were noted. During the next 24 hours, weakness progressed to involve both upper limbs and the right facial nerve (HouseBrackmann grade III). External ophthalmoplegia was not noted. Nerve conduction study done on the 4 day gave the following results as shown in Table 1.