Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
A
0%
0/0
B
C
D
E
Select Answer to see Preferred Response
This patient with a recent history of gastroenteritis (recent history of diarrhea) who presents with progressive ascending weakness and sensory loss, as well as diminished reflexes, most likely has Guillain-Barre syndrome. This disease would present with an isolated increase in cerebrospinal fluid (CSF) protein levels without an increase in white blood cell count or glucose (answer choice C). Guillain-Barre syndrome is an immune-mediated polyneuropathy that is thought to be due to cross-reactivity between pathogenic antigens and host myelin. A classic association is with a previous diarrheal infection caused by Campylobacter jejuni. When Guillain-Barre syndrome is suspected, a panel of tests should be performed. Spirometry allows for the determination of whether the patient's respiratory function is adequate and can guide whether early intubation is necessary. Nerve conduction studies will reveal slowed conduction velocity and reduced amplitude in compound muscle action potentials. Finally, lumbar puncture is able to support the diagnosis and will classically show albuminocytologic dissociation with elevated protein but a normal white blood cell count. Treatment includes supportive management and immunomodulatory therapy with intravenous immune globulin or plasma exchange. Rath et al. discuss different methods of quantifying the classic finding of albuminocytologic dissociation in patients with Guillain-Barre syndrome. The authors find that a longer duration from clinical onset to lumbar puncture was associated with a higher diagnostic yield. They recommend using the CSF/serum albumin quotient to test for this disease. Figure A is a table showing the results of CSF testing after a lumbar puncture. Incorrect Answers: Answer 1: Normal protein, normal glucose, and normal white cells in the CSF would be seen in peripheral causes of weakness such as myasthenia gravis. This disease would present with weakness greater after muscle use or at the end of the day. Weakness improves with rest and pyridostigmine administration. Answer 2: Normal protein, normal glucose, and elevated white cell count in the CSF would be seen in viral meningitis. This disease would present with headache and neck stiffness with photophobia. Patients do not present as ill as those with bacterial meningitis. Answer 4: Increased protein, decreased glucose, and elevated white cell count in the CSF would be seen in bacterial meningitis. This disease would present with rapid onset of neurologic deficits, headache, and fever. Answer 5: Increased protein, normal glucose, and elevated white cell count in the CSF would be seen in fungal meningitis. This disease typically presents in immunocompromised patients with neurologic deficits. Bullet Summary: Guillain-Barre syndrome presents with ascending paralysis and albuminocytologic dissociation in the cerebrospinal fluid.
5.0
(1)
Please Login to add comment