iatroX Rounds #24
The clues
- 1
A 32-year-old man presents with a two-day history of progressive weakness and tingling in both of his feet and legs.
- 2
He mentions that three weeks ago he suffered from a self-limiting bout of watery diarrhoea and abdominal cramps after a barbecue.
- 3
The weakness has ascended rapidly over the last 24 hours, now affecting his hands and making it difficult for him to stand from a chair.
- 4
On examination, there is symmetrical reduced power in the lower limbs with complete absence of knee and ankle tendon reflexes.
- 5
His heart rate shows unexpected fluctuations between 50 and 120 bpm, and his forced vital capacity is being monitored closely at the bedside.
- 6
Lumbar puncture reveals a cerebrospinal fluid protein level of 1.4 g/L with a total white cell count of only 2 cells per microlitre.
Guillain-Barré syndrome is an acute, immune-mediated polyradiculoneuropathy that typically follows a gastrointestinal or respiratory infection. It is characterized by an ascending paralysis and is a potential neurological emergency due to the risk of respiratory failure.
- Symmetrical, ascending muscle weakness
- Areflexia or significantly reduced tendon reflexes
- Autonomic dysfunction such as tachycardia or blood pressure lability
- Albuminocytologic dissociation in the cerebrospinal fluid
for education and entertainment. not medical advice.