Although less common, few patients who contract rabies develop an ascending paralysis, very much like of Guillain-Barré syndrome. History and exposure to animal is of paramount importance to distinguish between two. Preceded by prodromal symptoms patient develop a flaccid paralysis. Clinical exam is important as paralysis is more pronounced in the bitten limb. It can ascends either symmetrically or asymmetrically accompanied by possible fasciculations, and loss of deep tendon and plantar reflexes.
Simultaneously patient complain of headache, pain in the bitten muscles, and mild sensory disturbance. Nuchal rigidity and cranial nerve palsies may be present. Ascending paralysis culminates into dense paraplegia, loss of sphincter tone and fatal paralysis of the muscles of deglutition and respiration.
Interestingly, in contrast to conventional form of rabies hydrophobia is unusual.
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References:
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