A Flaccid Body!

Topic: Adult

Created on Wednesday, October 22 2008 by rednucleus

Last modified on Saturday, October 25 2008.

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

 

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This question was created on October 22, 2008 by rednucleus.
This question was last modified on October 25, 2008.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS

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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)

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B) 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)

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C) 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)

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D) 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)

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E) 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)

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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:

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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