Guillain-Barré syndrome (GBS): The Daily PANCE Blueprint
A 36-year-old had a recent GI infection and now has progressive ascending weakness. What’s the best initial test?
A. Lumbar puncture
B. MRI spine
C. Electromyography (EMG)
D. Serum creatine kinase
E. Acetylcholine receptor antibodies
Answer and topic summary
The answer is A. Lumbar puncture
Guillain-Barré syndrome (GBS) is an acute immune-mediated polyneuropathy often triggered by infections like Campylobacter jejuni. It presents with progressive, symmetric ascending weakness, areflexia, and possible autonomic dysfunction. The best initial test is a lumbar puncture, which shows elevated cerebrospinal fluid (CSF) protein with a normal WBC count (albuminocytologic dissociation). Electromyography (EMG) and nerve conduction studies confirm the diagnosis. Management includes IVIG or plasmapheresis; steroids are not effective.
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