Guillain-Barré Syndrome (GBS): The Daily PANCE Blueprint
A 34-year-old male presents with symmetric ascending weakness that began in his feet and has now progressed to his upper extremities and respiratory muscles. He notes a recent diarrheal illness two weeks prior. On physical exam, he has absent deep tendon reflexes and diminished sensation in his hands and feet. The patient is admitted for close monitoring of his respiratory function. Which of the following is the most classic cerebrospinal fluid (CSF) finding in this condition?
A. High WBC, low glucose
B. Normal protein, high WBC
C. High protein, normal WBC
D. Oligoclonal bands
E. Xanthochromia
Answer and topic summary
The answer is High protein, normal WBC
This patient’s presentation of symmetric ascending weakness following a recent infection is classic for Guillain-Barré Syndrome (GBS). GBS is an autoimmune disorder in which the body’s immune system attacks its own peripheral nerves. The hallmark CSF finding, known as albuminocytologic dissociation, is characterized by a markedly elevated protein concentration with a normal white blood cell (WBC) count. This finding is a key diagnostic clue and is thought to be due to inflammation of the nerve roots, which increases the permeability of the blood-nerve barrier, allowing protein to leak into the CSF. Treatment for GBS involves supportive care, including close monitoring of respiratory status, and immunomodulatory therapies such as intravenous immunoglobulin (IVIG) or plasmapheresis to shorten the course and severity of the illness.
Incorrect Answer Explanations:
- A. High WBC, low glucose: This CSF profile is a classic finding for bacterial meningitis, indicating an infectious process within the central nervous system.
- B. Normal protein, high WBC: This finding, particularly a lymphocytic pleocytosis, is characteristic of viral meningitis.
- D. Oligoclonal bands: The presence of oligoclonal bands in the CSF, which are immunoglobulins, is a key diagnostic marker for multiple sclerosis, a chronic inflammatory demyelinating disease of the central nervous system.
- E. Xanthochromia: This yellow-orange discoloration of the CSF is a pathognomonic finding for a subarachnoid hemorrhage, resulting from the breakdown of red blood cells in the CSF.
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