Guillain-Barre Syndrome (GBS) usually present as1 symmetrical ascending muscle weakness associated with areflexia and flaccidity with or without sensory symptoms. However,2 in some patients it may present atypically and one of the rare variant is Pharyngeal-cervical-brachial variant, usually presented as muscle weakness extending from cervical area to the upper extremities often affected with proximal muscle groups.

A 20-year-old male presented in ER with complaints of weakness over bilateral upper limb, dysphagia and difficulty in speaking followed by quadriparesis and breathing difficulty. Diagnosis of PCB variant was made by CSF and nerve conduction study and all other possible differentials were excluded.The patient improved by administration of iv immunoglobulin and other supportive measures. Physicians should think about PCB variant of GBS, whenever a patient presenting with symmetrical upper limb weakness and bulbar palsy