Guillain-Barre syndrome-like illness in association with electrical shock injury

A 19-year-old man presented 4 weeks after an electrical shock injury with gradual onset limb weakness, altered sensation in the peripheries and respiratory difficulty. There was immediate tingling of the fingers following the electrical injury that persisted. He subsequently had transient facial weakness responsive to oral steroids before the development of further limb symptoms. On admission the clinical picture and investigation findings, including neurophysiology, cerebrospinal fluid examination and MRI were consistent with a Guillain-Barre syndrome. He was managed with a course of intravenous immunoglobulin and extensive physiotherapy and occupational therapy. He made an initial modest improvement but worsened again over the subsequent 4-6 weeks. Further investigation identified no ongoing active disease and he is left with a significant residual deficit.