Guillain-Barré Syndrome Presenting as Pseudo-Cerebellar Syndrome: A Case Report from a Resource-Limited Setting in Sub-Saharan Africa

Guillain-Barré Syndrome (GBS) is the most frequent cause of acute flaccid paralysis worldwide, with significant morbidity and mortality in the absence of timely treatment. It is an immune-mediated acute inflammatory poly-radiculoneuropathy, usually triggered by infection. While the classical presentation is ascending symmetrical weakness with areflexia, atypical forms may mimic other neurological disorders and delay diagnosis. We report a rare pseudo-cerebellar presentation in a middle-aged man in a low-resource setting, highlighting diagnostic challenges and the importance of multidisciplinary supportive care. A 52-year-old teacher with no medical history presented with a 4-day history of progressive gait unsteadiness resembling cerebellar dysfunction. Neurological examination revealed global areflexia, wide-based stance, but preserved cognition and coordination tests. Brain and spine MRI were unremarkable. By day 7, cerebrospinal fluid (CSF) analysis showed albuminocytologic dissociation. On day 10, nerve conduction studies confirmed diffuse demyelination consistent with the acute in-flammatory demyelinating polyradiculoneuropathy (AIDP) subtype of GBS. The patient subsequently developed ascending flaccid paraparesis with mild autonomic dysfunction, without respiratory compromise. Due to unavailability of intravenous immunoglobulin (IVIg) and plasmapheresis, treatment was limited to supportive care, physiotherapy, and preventive measures against complications. The patient showed gradual recovery over four weeks, regaining partial autonomy, and was referred for rehabilitation. This case underscores the diagnostic complexity of GBS variants that mimic central nervous system pathology. In resource-limited settings, reliance on clinical skills remains crucial, especially where access to neurophysiology, CSF analysis, and disease-modifying therapies is limited. Despite the lack of specific treatment, supportive multidisciplinary management enabled significant recovery. Wider access to IVIg and plasmapheresis is urgently needed in low-income countries.