Abstract

Dr. Saraswathi Yashaswini*, Dr. Gopinath

ABSTRACT

Background: Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis and is typically sporadic; familial clustering has been documented only rarely worldwide, with a handful of reports from India. We describe two brothers who each presented with an acute, ascending, symmetric flaccid paralysis fulfilling the clinical picture of acute inflammatory demyelinating polyradiculoneuropathy (AIDP), the demyelinating subtype of GBS. Case Presentation: Case 1, a 47-year-old man, presented with a 15-day history of low-grade intermittent fever, followed by tingling in the feet and hands and a rapidly ascending, symmetric flaccid quadriparesis evolving over four days, with areflexia and a large-fibre (vibration and joint-position) sensory deficit in the hands and feet; pain, temperature and crude touch were preserved. Case 2, his 35-year-old brother, presented separately with a more gradually evolving (over several weeks) ascending, symmetric, proximal and distal flaccid weakness of all four limbs with global areflexia but a fully intact sensory examination. Neither patient had cranial nerve, bulbar, respiratory, bowel or bladder involvement. Both were provisionally diagnosed with acute areflexic flaccid paralysis, most consistent with AIDP/GBS. (CSF analysis showed albumino- cytological dissociation in both patients and nerve conduction studies in case 1 showed early AIDP with prolonged latencies, slowed motor speeds, and "sural sparing" where sensory nerves in the legs remain normal. Case 2 shows severe, advanced AIDP marked by widespread absent F-waves and significant conduction blocks in multiple motor nerves.). Conclusion: The near-simultaneous occurrence of clinically classical GBS/AIDP in two brothers is a rare event that raises the possibility of a shared genetic susceptibility, a common environmental or infectious trigger, or both. This case adds to the small body of literature on familial GBS and underscores the value of documenting family history and offering genetic/immunological work-up in such clusters.