Guillain-Barré syndrome is an autoimmune condition typically characterized by progressive areflexic ascending motor deficit and paresthesia. However, atypical presentations, such as isolated facial diplegia, are rare and diagnostically challenging. We describe a unique case of Guillain-Barré syndrome in a 46-year-old male patient, presenting as isolated bilateral facial paralysis without preceding medical history. Symptoms included tongue heaviness, loss of taste, dysarthria, and inability to close eyelids. A neurological examination confirmed bilateral facial paralysis. Laboratory tests and cerebrospinal fluid analyses were unremarkable, except for albumin-cytological dissociation. Electromyography revealed severe demyelinating damage to facial nerves. The patient responded well to intravenous immunoglobulin therapy. This case highlights the necessity of considering Guillain-Barré syndrome in patients with isolated facial diplegia. A thorough clinical evaluation, supported by laboratory and electromyographic findings, is crucial for accurate diagnosis and effective treatment. Early identification and intervention are key for optimal outcomes in these atypical presentations.

Intensive Care Unit (ICU)-Acquired Weakness (ICU-AW) is a generalized muscle weakness that is clinically detected in critical patients and has no plausible etiology other than critical illness. ICU-AW is uncommon in patients undergoing orthotopic liver transplantation (OLT). Our report sheds light on the highest number of ICU-AW cases observed in a single center on OLT patients with early allograft dysfunction. Out of 282 patients who underwent OLT from January 2015 to June 2023, 7 (2.5%) developed generalized muscle weakness in the ICU and underwent neurophysiological investigations. The neurologic examination showed preserved extraocular, flaccid quadriplegia with the absence of deep tendon reflexes in all patients. Neurophysiological studies, including electromyography and nerve conduction studies, showed abnormalities with fibrillation potentials and the rapid recruitment of small polyphasic motor units in the examined muscles, as well as a reduced amplitude of the compound muscle action potential and sensory nerve action potential, with an absence of demyelinating features. Pre-transplant clinical status was critical in all patients. During ICU stay, early allograft dysfunction, acute kidney injury, prolonged mechanical ventilation, sepsis, hyperglycemia, and high blood transfusions were observed in all patients. Two patients were retransplanted. Five patients were alive at 90 days; two patients died. In non-cooperative OLT patients, neurophysiological investigations are essential for the diagnosis of ICU-AW. In this setting, the high number of red blood cell transfusions is a potential risk factor for ICU-AW.

UNASSIGNED: Comparison of early effects of supervised (led by physiotherapist) and unsupervised rehabilitation protocols in patients with myofascial pain syndrome, disk-root conflict and degenerative spine disease at cervical level.
UNASSIGNED: Three groups of patients (n = 60 each) with clinically and neurophysiologically confirmed myofascial pain syndrome, disk-root conflict and degenerative spine disease were randomly subdivided to supervised and unsupervised treatment subgroups (n = 30 each). Thirty healthy subjects with similar demographic and anthropometric properties as patients were enrolled to control group. Patients were examined before and after rehabilitation with visual analog scale of pain, Spurling\'s test, painful passive elongation and active trigger points detection in trapezius muscle, sensory perception studies and surface electromyography (at rest, during maximal contraction) and electroneurography.
UNASSIGNED: Supervised treatment resulted in decrease of pain intensity (P = .001) and Spurling\'s symptoms incidence (P = .008) in patients from disk-root conflict group. Painful elongation and incidence of trigger points in trapezius muscle were the least observed at P = .009 after supervised therapy of myofascial pain syndrome. Supervised therapy resulted in decrease of resting electromyography amplitude and increase of maximal contraction electromyography amplitude from trapezius muscle (P = .02) in myofascial pain syndrome patients and from biceps and abductor pollicis brevis muscles of patients from other groups (P from .05 to .001). Median nerve electroneurography and sensory perception results improved at P = .05 after supervised treatment in disk-root conflict group.
UNASSIGNED: Twenty-day supervised rehabilitation provides better therapeutic effects than unsupervised one in treatment of muscle dysfunctions in patients with myofascial pain syndrome, degenerative changes and disk-root conflict at cervical spine.

OBJECTIVE: Bifacial weakness with paraesthesias subtype of Guillain-Barré syndrome (GBS) is thought to be demyelinating in nature but the evolution of serial nerve conduction study (NCS) findings has not been studied. We retrospectively analyzed the changes on serial NCS of patients with bilateral facial neuropathy.
METHODS: We described the clinical features, serial blink reflex, facial nerve and limb NCS of such patients.
RESULTS: Five patients fulfilled our study criteria. Patients 1 and 2 were diagnosed clinically to have bilateral Bell\'s palsy, patients 3 and 4 as bifacial GBS subtype and patient 5 as facial palsy associated with acute HIV infection. In all, the initial neurophysiological tests showed absent blink response and normal facial NCS. Patient 1\'s repeat tests were normal. Patient 2\'s repeat blink reflex showed mildly prolonged latency. Repeat blink reflex latency of patients 3, 4 and 5 were in the demyelinating range. Patient 3 also had prolonged facial nerve latency. Patients 3 and 4 had serial limb NCS showing progressively prolonged latency.
CONCLUSIONS: Serial NCS suggests that the bifacial GBS subtype is demyelinating in nature.
CONCLUSIONS: This study provides further evidence for a bifacial subtype of GBS with a demyelinating pathophysiology.