BOF: 8
A 40-year-old male presents with a history of rapidly
progressive weakness of his legs of 4 days duration. He gives a history of
gastroenteritis about 3 weeks prior to this. He has been otherwise fit and
healthy. He does not smoke or drink and does not take any medication.
On examination he has a flaccid weakness of his lower
limbs with absent reflexes. There is impairment of sensation upto his thighs.
Investigations reveal normal haematology and
biochemistry. Lumbar puncture is performed and this shows:
Pressure 16 mm CSF
CSF protein 3.4 g/dL
CSF glucose 4 mmol /L
Leucocytes 5/mL
Gram stain – no organisms
Plasma glucose 4.5 mmol/L
In this patient which one of the following would give the
patient the most benefit:
a)
High dose steroids
b)
Intravenous immunoglobulin
c)
Intravenous acyclovir
d)
Pyridostigmine
e)
Beta interferon
Answer: b)
The history of rapid onset of flaccid weakness following
a diarrhoeal illness would suggest the patient has Guillain-Barre syndrome.
The finding of high protein in the CSF is further evidence in favour of this.
Intravenous immunoglobulin and plasmapheresis are the
modalities used in treatment of this condition.
Revision Tip
Revise Guillain Barre syndrome
Keys to Success in Medicine page 474-475
