Objective: To report the case of a patient developing tremor in the course of Guillain-Barré Syndrome (GBS)

Background: Neuropathic tremor is a movement disorder that occurs in the context of peripheral neuropathy. The tremor can appear early in the course of GBS and may persist up to years after recovery of motor and sensory symptoms.

Method: Case report. Video content showing the tremor included.

Results: A 74-year-old man with hypertension and dyslipidemia was admitted to the hospital with a one week history of progressive weakness and inability to stand from a sitting position. The patient was a craftsman and was no longer able to do the usual manual work. There was an episode of diarrhea and subfebrile temperature two weeks before. Neurological examination showed tetraparesis with predominant distal muscle weakness and the achilles reflexes were absent. His cerebrospinal fluid showed albuminocytologic dissociation. Brain and spinal MRI were unremarkable and nerve conduction studies showed acute demyelinating polyradiculoneuritis. Pure motor GBS was assumed and the patient was treated with intravenous immunoglobulin (IVIg). Four days after admission he developed a symmetrical postural tremor affecting predominantly the hands, with a low frequency and amplitude of 1-2cm, confirmed in the Archimedes spiral. There was no rest or intention tremor, no rigidity or bradikinesia. The tremor improved with propranolol 10mg twice daily and was completely resolved 3 months later.

Conclusion: This case illustrates that acquired demyelinating polyneuropathies are capable of inducing tremor and treatment with low dosage propranolol can be effective.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-achilles-heel-of-a-craftsman-a-complication-of-guillain-barre-syndrome/