Guillain-Barré Syndrome Revealing Coexisting Cervical Spondylotic Myelopathy: A Diagnostic Pitfall.

Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy characterized by rapidly progressive weakness and areflexia. Although the diagnosis is usually straightforward, atypical clinical evolution should prompt investigation for concomitant central nervous system pathology. We report the case of a 64-year-old man initially diagnosed with severe GBS based on clinical presentation, cerebrospinal fluid (CSF) analysis, and electroneuromyography (EMNG) findings. Despite partial neurological improvement after intravenous immunoglobulin therapy, the patient later developed cervical pain, brisk reflexes, and a positive Babinski sign. Cervical magnetic resonance imaging (MRI) revealed severe multilevel cervical spondylotic myelopathy (CSM) with spinal cord compression and intramedullary T2 hyperintensity. Surgical decompression was subsequently indicated. This case highlights the importance of reassessing patients with GBS who develop pyramidal signs or atypical neurological findings, as concomitant cervical myelopathy may be overlooked and delay appropriate management.