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Question
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A 35 year old male presents with two weeks history of ascending weakness and areflexia. Which of these features will not be consistent with a diagnosis of Guillain barre syndrome?
Explanation
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Ocular abnormalities (paresis, pupillary abnormalities, ptosis) while suggesting botulism or tick paralysis, may be seen in up to 20 % of GBS. While pleocytosis is not seen in GBs, approximately 15 % of patients have CSF leucocytes between 15-50/cmm. CSF pleocytosis should raise possibility of infective or neoplastic processes also. Nerve conduction findings may be non specific ( F wave and H reflex abnormalities) Presence of sural sparing (normal sural responses in presence of abnormal upper limb sensory abnormality) is seen in GBS. This finding will not be seen in length dependent neuropathies, hence absent sural response two weeks into the illness would be inconsistent with GBS. Enhancement of nerve roots is seen in 95% of cases.
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Reference
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Donofrio P. Guillain-Barre Syndrome. Continuum 2017;23(5):1295-1309.
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Option 1
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Is Correct (Option 1):
Bilateral ptosis
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Option 2
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Is Correct (Option 2):
CSF showing 30 leucocytes
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Option 3
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Is Correct (Option 3):
Absent sural sensory potentials
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Option 4
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Is Correct (Option 4):
Enhancement of nerve roots on MRI
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