sickle cell anemia; Guillain-Barré syndrome; autoimmune diseases of the nervous system; ascending paralysis; acute autoimmune neuropathy; physical examination; male


Internal Medicine | Neurology


A 24-year-old African American male with a history of sickle cell anemia (Hb S/S) presented to an outside hospital with acute colitis, acute renal failure and sickle cell crisis and was treated with supportive measures. On day 3 of hospitalization, he developed bilateral ascending paralysis with sacral numbness. Magnetic resonance imaging (MRI) demonstrated epidural lipomatosis, which was attributed as the cause of his paralysis. He was transferred to our facility for neurosurgery evaluation. Based on the physical examination, Guillain-Barré Syndrome (GBS) was suspected. This conclusion lead to a lumbar puncture with cerebrospinal fluid (CSF) analysis that confirmed the diagnosis. He was then treated with intravenous immunoglobulin (IVIg), which resolved his symptoms.

We present this case to highlight the importance of a physical exam rather than relying heavily on imaging studies. Physical exam findings lead to a diagnosis, which was then confirmed with appropriate testing.