A 26 year old male presents to your Emergency Department with bilateral lower extremity weakness.  He states he recently had a “stomach bug” following a camping trip.  You suspect Guillain-Barre Syndrome.  Which of the following is most consistent with GBS?

A) CSF with elevated protein 

B) Hyperreflexia

C) Facial droop 

D) Sterile pyuria 

E) Vesicular rash 

The correct answer is (A) CSF with elevated protein.

Guillain-Barre Syndrome Pearls

• Immune mediated peripheral nerve myelin sheath/axon destruction 
• Classically viral illness followed by ascending symmetric weakness/paralysis with areflexia/hyporeflexia
• 1/3 of patients have paralysis ascending to diaphragm and require mechanical ventilation 
• Common preceding infections: campylobacter jejuni, zika virus, cytomegalovirus, epstein barr virus, mycoplasma pneumoniae 
• Diagnosis mostly clinical however LP can help (CSF with high protein and low WBC)
• Both IVIG and plasma exchange can shorten time to recovery
• Miller Fisher Syndrome = variant characterized by ophthalmoplegia, ataxia, and areflexia 

REFERENCES: 

Tintinalli, JE. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw-Hill Education LLC, 2016.