Guillain-Barré syndrome — SCE Neurology MCQ

Correct answer: A — Monitored respiratory admission with intravenous immunoglobulin

The best answer is “Monitored respiratory admission with intravenous immunoglobulin”. Non-ambulant GBS with bulbar involvement and a rapidly falling low vital capacity has imminent ventilatory risk; close respiratory monitoring and IVIg or plasma exchange should not await hypoxaemia. “Give high-dose oral prednisolone and review respiratory function tomorrow” is less appropriate because corticosteroids do not improve typical GBS and delayed monitoring is unsafe “Discharge with daily community spirometry because oxygen saturation is normal” is less appropriate because oxygen saturation can remain normal until late ventilatory failure “defer intervention until nerve-conduction confirmation before respiratory escalation” is less appropriate because typical clinical disease with respiratory decline requires action while neurophysiology is arranged “Arrange elective sural-nerve biopsy before disease-modifying treatment” is less appropriate because nerve biopsy is not required in a typical acute inflammatory polyradiculoneuropathy

Reference: EAN/PNS guideline on diagnosis and treatment of Guillain–Barré syndrome. https://onlinelibrary.wiley.com/doi/10.1111/jns.12575