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Guillain-Barré syndrome — ABIM Board MCQ

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ModerateNeurologyGuillain-Barré syndromeABIM Board

A 39-year-old develops progressive ascending weakness and areflexia two weeks after diarrheal illness. CSF shows high protein with two white cells/mm3, and nerve conduction studies show demyelination. What mechanism is most likely?

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Correct answer: C — Acute immune-mediated peripheral nerve and nerve-root demyelination

The best answer is “Acute immune-mediated peripheral nerve and nerve-root demyelination”. This is acute inflammatory demyelinating polyradiculoneuropathy, the common GBS form. Albuminocytologic dissociation reflects root inflammation without marked CSF pleocytosis. Anterior-horn disease causes a different motor pattern, and neuromuscular-junction, basal-ganglia and cerebellar disorders do not cause ascending areflexic neuropathy.

Reference: AAN Practice Guideline: Immunotherapy for Guillain-Barré Syndrome: https://www.aan.com/Guidelines/home/GuidelineDetail/115