Guillain-Barré Syndrome

To the Editor.—  Idiopathic polyneuritis (Guillain-Barré syndrome) is an interesting and relatively common neurological problem. The following case illustrates an almost unique example.

Report of a Case.—  A 59-year-old man was in excellent health until he developed a 48-hour illness characterized by diarrhea, low-grade fever, and generalized malaise. Three days after recovery he noted a change in his voice and a slight difficulty in swallowing, without any sore throat. When these symptoms persisted, he was admitted to the hospital the following day. Neurological examination 24 hours later revealed an alert and well-developed man with mild, bilateral impairment of masseter function, a severe bilateral seventh nerve palsy, a diminished gag reflex, and marked impairment of tongue movements. He was extremely dysarthric and was having some difficulty swallowing. Eye movements were full and there was no ptosis nor diplopia with red glass testing. Deep tendon reflexes were brisk and motor strength was