SHM Converge Scientific Abstract ePoster Gallery-A Case of Ascending Paralysis in a Teenager With Autism

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A 14-year-old boy with autism spectrum disorder presented with refusal to move, imbalance, and weakness after a diarrheal illness. Initial findings, including lower-extremity areflexia, mild proximal weakness, cauda equina nerve root enhancement on MRI, and near-normal cerebrospinal fluid, suggested Guillain-Barré syndrome (GBS). He was treated with IV immunoglobulin, but his condition worsened.<br /><br />He later developed right facial droop, upward gaze limitation, vertical nystagmus, slurred speech, bilateral tingling, and ascending paralysis severe enough to require intubation. Repeat evaluation showed multiple nutritional deficiencies, including thiamine (B1), B12, folate, and elevated methylmalonic acid. Brain MRI demonstrated bilateral medial thalamic and other characteristic lesions consistent with Wernicke’s encephalopathy. He improved after aggressive thiamine, B12, and folate replacement, with recovery of mental status and eventual extubation.<br /><br />This case highlights that thiamine deficiency can closely mimic GBS, especially when weakness and areflexia follow an illness. In children with autism or food selectivity, nutritional deficiency should be strongly considered when neurologic symptoms are unexplained or progress despite standard GBS therapy. Early recognition is critical to avoid unnecessary treatment delays and to prevent permanent neurologic injury.

Asset Subtitle

Caroline Cwalina

Meta Tag

Author List Amber Vozar, Caroline Cwalina, Chickajajur S. Vijay, Giles Knowles, Morgan Decker

Category Clinical Vignettes

Concept Ascending paralysis

Concept Areflexia

Concept Thiamine Deficiency

Concept Guillain-Barré Syndrome

Concept Wernicke Encephalopathy

Distinguished Non-Finalist

Presenter Organization WVU Medicine

Presenting Author Caroline Cwalina

Track Pediatric

Keywords

Guillain-Barré syndrome

Wernicke encephalopathy

thiamine deficiency

autism spectrum disorder

nutritional deficiency

areflexia

ascending paralysis

brain MRI

vitamin B12 deficiency

pediatric neurology

Ascending paralysis

Areflexia

Thiamine Deficiency

Guillain-Barré Syndrome

Wernicke Encephalopathy