Background: Guillain–Barré syndrome (GBS) is an immune-mediated disorder of the nervous system that shows acute or subacute onset. It is also known as Landry's paralysis. It is characterized by muscle weakness of legs and arms, limb paresthesias, and total or relative areflexia. Acute motor sensory axonal neuropathy (AMSAN) is a distinct subtype of GBS. It is not only a rare but severe variant that involves axonal degeneration in motor and sensory nerve fibers and has a prolonged recovery course. Case description: A 60-year-old male presented to the emergency department having complaints of weakness, numbness, and tingling sensation in feet for the last fortnight, which ascended gradually towards the calves. He was observed to have a sensory disorder in hands, but not flaccid paralysis. The patient history and nerve conduction studies were indicative of AMSAN variant of GBS. Discussion: In patients of AMSAN, the reduction of sural nerve amplitude is more pronounced as compared to acute inflammatory demyelinating polyneuropathy (AIDP) patients. In case of our patient, the electrophysiological feature indicated a more than 50% decrease in SNAP. A marked reduction in sensory nerve action potential and compound muscle action potential with only slightly decreased conduction velocities is a requirement for the diagnosis of axonal neuropathies, which is the trait seen in the reported case.
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