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Guillain-Barre syndrome — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

HardNeurologyGuillain-Barre syndromeABIM Board

A 49-year-old develops rapidly ascending weakness 12 days after gastroenteritis. He cannot walk unaided, has areflexia and albuminocytologic dissociation. Forced vital capacity falls from 22 to 17 mL/kg over four hours, but he is still protecting his airway. Which management is most appropriate?

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Reveal the answer and explanation

Correct answer: E — Begin IV immunoglobulin with serial respiratory and autonomic monitoring

The best answer is “Begin IV immunoglobulin with serial respiratory and autonomic monitoring”. Progressive GBS with inability to walk and declining vital capacity warrants IVIG or plasma exchange plus close respiratory and autonomic monitoring. Corticosteroids are ineffective, and treatment should not wait for overt ventilatory failure.

Reference: AAN Practice Parameter: Immunotherapy for Guillain-Barré Syndrome: https://pubmed.ncbi.nlm.nih.gov/14504313/