Bilateral Facial Paralysis with Paresthesias, Guillain-Barré Variant: A Case Report

A 42-year-old patient with no prior medical history presented with a one-week history of an inability to close his eyelids, swelling of the cheeks, and tingling sensations in the feet. These symptoms were preceded by a flu-like illness two weeks earlier. Clinical examination revealed bilateral facial diplegia with Charles Bell’s sign, an inability to puff out the cheeks or whistle, but no facial sensory disturbances. Muscle strength was normal in all four limbs, with absent deep tendon reflexes in the lower limbs. Electroneuromyography showed bilateral facial nerve involvement, with an absent blink reflex and prolonged F waves in the lower limbs. Lumbar puncture revealed albuminocytological dissociation (CSF protein at 0.8 g/L with no pleocytosis). Infectious and immunological workups were negative, and brain MRI was normal. A diagnosis of Guillain-Barré syndrome with predominant facial involvement was made. The patient was treated with prednisolone at 1 mg/kg/day and motor rehabilitation. At three months, partial recovery was observed, with persistent residual facial paresis.