Abstract
RATIONALE: Gullain-Barré syndrome (GBS) is a rare autoimmune condition primarily presenting with symmetrical progressive limb weakness. It is frequently associated with sensory and autonomic symptoms and autonomic disturbances and often manifests seropositivity for anti-ganglioside antibodies. Infections are considered major precipitants; however, GBS post-craniotomy for severe traumatic brain injury is a rarity. PATIENT CONCERNS: A 79-year-old female underwent craniotomy for a cerebellar contusion sustained from severe traumatic brain injury, leading to quadriplegia, autonomic dysfunction, dilated pupils, and respiratory failure. However, the patient's GBS manifested slightly differently. Her limb weakness was asymmetric and progressed from 1 upper limb to the other. DIAGNOSES: The diagnosis of GBS was confirmed based on clinical presentation, cerebrospinal fluid analysis showing albuminocytologic dissociation, and the detection of anti-sulfatide antibodies in serum. INTERVENTIONS: The patient received intravenous immunoglobulin (IVIG) therapy at 2 g/kg daily, along with supportive measures including mechanical ventilation and rehabilitation. OUTCOMES: The patient demonstrated significant improvement within 5 days of IVIG treatment, achieving near-complete functional recovery with grade 4 muscle strength at discharge 6 weeks post-intervention. LESSONS: This case highlights the need to consider GBS in postoperative patients with acute limb weakness, even in atypical presentations. Early recognition and timely IVIG treatment are critical for favorable outcomes.