Hyperreflexia in a patient with motor axonal Guillain-Barre syndrome

We report a patient who presented after an episode of diarrhoea with ascend ing, symmetrical weakness without sensory loss, and without sphincter or ot her autonomic dysfunction. On clinical examination there were no cranial ne rve deficits. Hyperreflexia of tendon jerks without other upper motor neuro ne signs was found. Electrophysiological examination demonstrated acute dis tal symmetrical motor axonal polyneuropathy. No electrophysiological signs of peripheral nerve demyelination or central nervous system involvement wer e found. Albuminocytologic dissociation was present in the cerebrospinal fl uid. Stool culture and serological tests were inconclusive. Our patient's clinical picture was, apart from hyperreflexia of tendon jerk s throughout the disease, characteristic of Guillain-Barre syndrome. This i s the first such patient reported in Europe. The aetiology remained unclear . We suggest that selective axonal motor fibre affection, with possible mil d pyramidal involvement, caused tendon jerk hyperreflexia.