Clinical Practice and Cases in Emergency Medicine

Introduction: Acute motor and sensory axonal neuropathy is a rare, severe axonal variant of Guillain–Barré syndrome characterized by rapidly progressive motor and sensory dysfunction. Early recognition in the emergency department (ED) is challenging because patients may initially present with subtle neurologic findings, preserved reflexes, and normal cerebrospinal fluid (CSF) studies. 

Case Report: A 29-year-old woman with a history of generalized anxiety disorder presented to the ED with progressive distal numbness and mild weakness, with weakness being her chief complaint. Neurologic examination demonstrated preserved reflexes without focal deficits, and she was noted to be anxious. Given the reassuring examination, the patient was discharged with strict return precautions, including instructions to seek immediate reevaluation for worsening weakness, numbness, or progression of neurologic symptoms. She returned 48 hours later with rapidly worsening ascending weakness. The patient’s clinical progression prompted neurology consultation and hospital admission despite initially reassuring examination findings. During a five-day hospitalization, electrodiagnostic testing and clinical findings established the diagnosis of acute motor and sensory axonal neuropathy. 
This case illustrates how acute motor and sensory axonal neuropathy may initially mimic benign or functional conditions, particularly in patients with underlying anxiety, preserved reflexes, and normal early CSF findings. In the ED, anchoring bias and premature diagnostic closure may delay recognition of serious neurologic disease. Serial neurologic examinations, maintaining a broad differential diagnosis, and early neurology consultation are critical when evaluating patients with progressive neurologic symptoms. 

Conclusion: Acute motor and sensory axonal neuropathy may present atypically during the early stages of disease, and initial examination and laboratory findings may be misleading. Clinical progression, rather than isolated examination or diagnostic findings, should guide disposition and prompt reassessment to facilitate timely diagnosis and treatment, with the potential to improve patient outcomes.