FrontalCortex, Inc. is a non-profit corporation dedicated to neurology education.

A Flaccid Body!

Topic: Adult

Created on Wednesday, October 22 2008 by rednucleus

Last modified on Saturday, October 25 2008.

A 21-year-old college student is brought to the ER short of breath 2 days after having difficulty walking which started 4 days ago. The patient is dyspneic but fully conscious.Examination reveals flaccid areflexic quadriparesis of grade 2, proximal and distal, with normal sensation. His planters are down. His roommate says that the patient had a short-lived diarrheal illness 2 weeks ago. Which one of the following would cast a doubt upon your diagnosis?

 
        A) Normal nerve conduction studies during the first week
 
        B) CSF pleocytosis with 4 cells, 50% neutrophils.
 
        C) Urinary bladder retention a few days after presentation
 
        D) CSF protein of 470 mg/dl
 
        E) Fluctuating blood pressure with hypertension and hypotension
 

 


Back to the question = Go back to the top of the page.
See another question like this one = Reload a different version of this question ().
Click here for a random question = Load a random question from the database.
Clone this question = Use this question as a template to create a totally NEW question.
Rate this question = Enter detailed rating for this question!
Average user rating for this question = 4 = How users like you have rated this question.
This question was created on October 22, 2008 by rednucleus.
This question was last modified on October 25, 2008.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) Normal nerve conduction studies during the first week

This answer is incorrect.


Nerve conduction studies will start to show features of demyelination (i.e. prolonged distal latencies, temporal dispersion of compound muscle action potential,...etc) at the end of the first week of the illness and even later.   (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this questionAverage user rating for this question = 4
Please log in if you want to rate questions.

 

 

 

 

 

 

 

 

 




B) CSF pleocytosis with 4 cells, 50% neutrophils.

This answer is correct.


The presence of neutrophils in the CSF (no matter how many, even one cell) is against the diagnosis of Guillain-Barre.   (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this questionAverage user rating for this question = 4
Please log in if you want to rate questions.

 

 

 

 

 

 

 

 

 




C) Urinary bladder retention a few days after presentation

This answer is incorrect.


The presence of sphincteric disturbances at the time of presentation (or if they are persistent after motor improvement) should question the diagnosis.   (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this questionAverage user rating for this question = 4
Please log in if you want to rate questions.

 

 

 

 

 

 

 

 

 




D) CSF protein of 470 mg/dl

This answer is incorrect.


Guillain-Barre syndrome is one of the few causes of very high CSF protein (other causes are TB meningitis, acoustic neuroma, and spinal subarachnoid block).   (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this questionAverage user rating for this question = 4
Please log in if you want to rate questions.

 

 

 

 

 

 

 

 

 




E) Fluctuating blood pressure with hypertension and hypotension

This answer is incorrect.


Dysautonomia is common in Guillain-Barre , and sudden cardiopulmonary arrest is one of the causes of death.   (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this questionAverage user rating for this question = 4
Please log in if you want to rate questions.

 

 

 

 

References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973) Advertising:
2. Kasper, D.L., Braunwald, E., Hauser, S.L., Longo, D.L., and Jameson, J.L., Fauci, A.S. (Eds.) (2004). Harrison's Principles of Internal Medicine, 16th Edition. McGraw Hill. New York. (ISBN:0071402357) Advertising:
Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this questionAverage user rating for this question = 4
Please log in if you want to rate questions.

 

FrontalCortex.com -- Neurology Review Questions -- Neurology Boards -- Board Review -- Residency Inservice Training Exam -- RITE Exam Review
adult
A Flaccid Body!
Question ID: 102208093
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 10/22/2008
Modified: 10/25/2008
Estimated Permutations: 120

User Comments About This Question:

0 user entries
Please log in if you'd like to add a comment.