Clinical Medicine Research 2019; 8(4): 85-92 http://www.sciencepublishinggroup.com/j/cmr doi: 10.11648/j.cmr.20190804.13 ISSN: 2326-9049 (Print); ISSN: 2326-9057 (Online) Acute Facial Dyplegia and Rhabdomyolisis: Case Report and Review of Literature Maria Sofia Cotelli 1 , Filippo Manelli 2 , Marinella Turla 1 1 Neurology Unit, Azienda Socio Sanitaria Territoriale Valcamonica-Esine, Brescia, Italy 2 Emergency Unit, Azienda Socio Sanitaria Territoriale Valcamonica-Esine, Brescia, Italy Email address: To cite this article: Maria Sofia Cotelli, Filippo Manelli, Marinella Turla. Acute Facial Dyplegia and Rhabdomyolisis: Case Report and Review of Literature. Clinical Medicine Research. Special Issue: Neurology Emergency. Vol. 8, No. 4, 2019, pp. 85-92. doi: 10.11648/j.cmr.20190804.13 Received: August 14, 2019; Accepted: August 26, 2019; Published: September 12, 2019 Abstract: In 1916, Guillain, Barré and Strohl reported on two cases of acute flaccid paralysis with high cerebrospinal fluid protein levels and normal cell counts-novel findings that identified the disease we now know as Guillain–Barré syndrome (GBS). 100 years on, we have made great progress with the clinical and pathological characterization of GBS. GBS is an acute/subacute-onset polyradiculoneuropathy typically presenting with sensory symptoms and weakness over several days, often leading to quadriparesis. Approximately 70% of patients report a recent preceding upper or lower respiratory tract infection or gastrointestinal illness. The interplay between the microbial and host factors that dictate whether and how the immune response shifts towards autoreactivity is still unclear, and nothing is known about the genetic and environmental factors that affect an individual's susceptibility to the disease. Facial Diplegia with Paresthesias is a rare localized variant of GBS in which patient presents with simultaneous facial diplegia, distal limb paresthesias and minimal or no motor weakness. Treatment with intravenous immunoglobulin or plasma exchange is the optimal management approach, alongside supportive care. A common misconception is that the Guillain–Barré syndrome has a good prognosis-but up to 20% of patients remain severely disabled and approximately 5% die, despite immunotherapy. We report the case of a woman with acute facial dyplegia and rhabdomyolisis improved after immunoglobulin treatment. Keywords: Facial Dyplegia, Hyperckemia, Guillain Barrè Syndrome 1. Introduction We report the case of a 63 years-old young woman who was admitted to the hospital due to persistent diffuse myalgias with myoglobinuria from about three days. About seven days before she come back from a travel to Cambodia, lasted two weeks. Once at home she suffered for about three days from nausea and vomit without fever, for which she taken antiemetics with benefits. Her medical history was unremarkable, except for previous excision of basocellular carcinoma, and untreated nodular goiter. Neurological examination was normal, she only referred diffuse painful myalgias. Cranial nerves, reflexes, strength and sensitivity resulted all normal. She performed blood exams which showed raised value of creatine kinase (2387 UI/L normal value 30-135). Renal function resulted normal. Electromyography resulted normal. The following day she suddenly developed facial dyplegia, with hypophonia, which was evaluated as grade 6 with House and Brackmann Scale. She also started to complain, after three hours, of worsening dysartria and severe dysphagia. Lumbar puncture wasn’t performed, due to the presence of Arnold Chiari malformation at brain computer tomography and magnetic resonance imaging. She was promptly moved to Intensive care Unit (ICU) due to worsening of dyspnea. Intravenous immunoglobulins 0.4 g/Kg were promptly administered for five days. While in ICU her Creatine kinase values promptly improved and after two days resulted normal. Electromyography and electroneurography, showed demyelinating type of facial palsy and involvement of upper arms nerves. Chest X-Ray, abdomen and ultrasound resulted negative. Other blood exams, particularly antinuclear antibodies, extractable nuclear antigens antibodies, anti-double strand