Intact thumb reflex in areflexic Guillain Barré syndrome: A novel phenomenon.

INTRODUCTION

Areflexia is one of the cardinal clinical features for the diagnosis of Guillain Barré syndrome. However, some patients may have sluggish proximal muscle stretch reflexes. Presence of thumb reflex, a distal stretch muscle reflex has not been documented in Guillain Barré syndrome.

MATERIALS AND

METHODS

We prospectively evaluated thumb reflex in Guillain Barré syndrome patients and age matched controls from April to September 2013.

RESULTS

There were 31 patients with Guillain Barré syndrome in whom thumb reflex could be elicited in all (24 brisk, 7 sluggish), whereas all the other muscle stretch reflexes were absent in 29 patients at presentation and the remaining two had sluggish biceps and quadriceps reflexes (P = 0.001). Serial examination revealed gradual diminution of the thumb reflex (P < 0.001). Rapid progression of weakness was associated with early loss of the thumb reflex.

CONCLUSION

Thumb reflex, a distal stretch reflex is preserved in the early phase of Guillain Barré syndrome.