CureusGuillain-Barré Syndrome in a Patient with Cervical Myelopathy and Lumbar Spinal Stenosis Following a Fall: A Diagnostic Challenge

🧩 Diagnostic Reasoning Exercise / Teaching Case

A 55-year-old man with poorly controlled diabetes and degenerative spinal disease presented with severe bilateral leg weakness and urinary incontinence after a fall. MRI demonstrated C5-C6 cord compression with T2 signal change and substantial lumbar stenosis. The structural findings initially supported neurosurgical localization, but weakness progressed into the upper limbs, reflexes became absent throughout, and respiratory difficulty developed. Sensation remained comparatively preserved, creating tension between the imaging abnormalities and the evolving examination.

Diagnostic Considerations

• Generalized areflexia argues for peripheral nervous system involvement rather than an isolated cervical cord lesion.
• Progressive upper-limb and respiratory involvement exceeds the expected distribution of focal lumbar stenosis.
• Significant cervical compression remains clinically relevant but does not necessarily explain the entire neurological syndrome.
• Albuminocytologic dissociation supports an acute inflammatory neuropathic process when interpreted alongside the clinical trajectory.
• Electrodiagnostic evidence of severe sensorimotor axonal polyneuropathy requires caution because longstanding diabetes can confound sensory responses.
• Infection and sepsis offer alternative explanations for fever and respiratory deterioration, limiting their diagnostic specificity.

Practice Pearls

• Reassess neurological localization when progressive deficits exceed the abnormalities demonstrated on imaging.
• Integrate serial reflex, sensory-level, cranial, motor, sphincter, and respiratory examinations.
• Avoid assuming that compelling structural imaging establishes a single explanation for acute weakness.
• Interpret cerebrospinal fluid and nerve conduction findings within the clinical timeline and relevant comorbidities.
• Recognize that central and peripheral neurological disorders can coexist rather than function solely as competing diagnoses.