All of the following statements about Guillain — Barre Syndrome are true, Except
Correct Answer: Descending
Description: Answer is C (Descending): Guillain Barre Syndrome is typically an 'ascending' (not descending) neuropathy. Guinan Barre Syndrome is typically an acute inflammatory demyelinating polvneuropathy. The usually pattern is an ascending paralysis and cranial nerve involvement is common. The typical/most common variant of GBS is Acute Inflammatory Demyelinating Polyneuropathy (AIDP). Diagnostic Features of Acute Inflammatory Demyelinating Polyneuropathy (AIDP) I. Required for Diagnosis 1. Progressive weakness of variable degree from mild paresis to complete paralysis 2. Generalized hyporeflexia or areflexiae II. Suppoive of Diagnosis 1. Clinical Features a) Symptom progression: Motor weakness rapidly progresses initially but ceases by 4 weeks. Nadir attained by 2 weeks in 50%, 3 weeks 80%, and 90% by 4 weeks. b) Demonstration of relative limb symmetry regarding paresis. c) Mild to moderate sensory signs. d) Frequent cranial nerve involvement: Facial (cranial nerve VII) 50% and typically bilateral but asymmetric; occasional involvement of cranial nerves XII, X, and occasionally III, IV, and VI as well as Xl. e) Recovery typically begins 2-4 weeks following plateau phase. 0 Autonomic dysfunction can include tachycardia, other an-hythmias, postural hypotension, hypeension, other vasomotor symptoms. g) A preceding gastrointestinal illness (e.g., diarrhea) or upper respiratory tract infection is common. 2. Cerebrospinal Fluid Features Suppoing Diagnosis a. Elevated or serial elevation of CSF protein. b. CSF cell counts are <10 mononuclear cell/mm'. 3. Electrodiagnostic Medicine Findings Suppoive of Diagnosis a) 80% of patients have evidence of NCV slowing/conduction block at some time during disease process. b) Patchy reduction in NCV attaining values less than 60% of normal. c) Distal motor latency increase may reach 3 times normal values. d) F-waves indicate proximal NCV slowing. e) About 15-20% of patients have normal NCV findings. f) No abnormalities on nerve conduction studies may be seen for several weeks. III. Findings Reducing Possibility of Diagnosis 1. Asymmetric weakness 2. Failure of bowel/bladder symptoms to resolve 3. Severe bowel/bladder dysfunction at initiation of disease 4. Greater than 50 mononuclear cells/mm3 in CSF 5. Well-demarcated sensory level IV. Exclusionary Criteria 1. Diagnosis of other causes of acute neuromuscular weakness (e.g., myasthenia gravis, botulism, poliomyelitis, toxic neuropathy). 3. Abnormal CSF cytology suggesting carcinomatous invasion of the nerve roots NCV, nerve conduction velocity.
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