Patient presents with sudden onset weakness of whole body, with similar episode in the past, bladder sparing was seen, diagnosis is
(A) Guillian Barre syndrome* Acute myelopathy (e.g., transverse myelitis, cord compression, infarct)Hyperreflexia, extensor plantar responses (although corticospinal tract findings may be absent early); trauma; absence of antecedent illness.Normal electrodiagnostic testing. Imaging of spine or cauda equina is often indicated to exclude spinal cord or cauda equina structural lesson.* Vasculitic neuropathyAsymmetric polyneuropathy or multifocal mononeuropathies; very painful, systemic symptoms (e.g., unexplained weight loss, fevers, rash); multiorgan involvement (e.g., joints, skin, kidney, respiratory tract); serologic markers (e.g., elevated sedimentation rate, rheumatoid factor); absence of an antecedent illness. Normal CSF Axonal polyneuropathy on electrodiagnostic testing.* Myasthenia gravisOcular (e.g., diplopia), bulbar (e.g., dysarthria), and limb weakness without sensory symptoms; fatigable, fluctuating symptoms; absence of an antecedent illness. Pattern of descending weakness. Normal CSF. Abnormal CMAP decrement on slow RNS studies.* BotulismInfants (most frequent) and at-risk adults (e.g., foodbome, such as exposure to home canned foods; from wound; injecting drug users). Nausea, vomiting, constipation, diplopia, ophthalmoplegia, ptosis, blurring of vision, dysphagia, dysarthria, urinary retention. Pattern of descending weakness.Normal CSF. Abnormal CMAP decrement on slow RNS studies. Abnormal CMAP facilitation on fast RNS.* West Nile encephalomyelitisFever, meningoencephalitis (may be mild), rash, abdominal pain, back pain; acute-onset lower motor neuronopathy. No sensory disturbance. CSF pleocytosis. Lower motor neuronopathy on electrodiagnostic testing.* Lyme neuroborreliosisEndemic area during tick season; meningitis, fever, myalgias, arthralgias, facial weakness; tick bite and rash. CSF pleocytosis. Axonal poly- radiculoneuropathy on electrodiagnostic testing.* Heavy metals (E.g., Arsenic) & other toxinsKnown exposure; neuropathy is accompanied by systemic symptoms (e.g., abdominal pain, diarrhea, constipation, rash, alopecia, central nervous system involvement); absence of an antecedent illness; prominent small-fiber nerve component (e.g., "burning" neuropathic pain).Unremarkable CSF. Axonal polyneuropathy on electrodiagnostic testing.* Tick paralysisChildren during tick season. Ataxic gait, diplopia, dysarthria, pupillary abnormalities (dilated pupils).No sensory complaints. Normal CSF. Low CMAPs and normal SNAPs on electrodiagnostic testing.Tick on scalp (e.g., behind the ear) or skin (e.g., nape of the neck).* Acute intermittent porphyriaAccompanying autonomic symptoms (tachycardia, hypertension, constipation, urinary retention), abdominal pain (usually severe), psychiatric andother CNS manifestations; patient with a history of prior suggestive attacks; axonal polyradiculoneuropathy or neuronopathy, often asymmetric.CSF resembles GBS with cytoalbuminological dissociation.* Buckthorn toxicityChildren living in the southwestern United States and Mexico; little or no sensory symptoms.* DiphtheriaPatient (e.g., from a developing country) with recent sore throat, fever, and multiple cranial neuropathies (e.g., diplopia, ptosis, dysarthria, dysphagia, numb tongue, gingivae and face). CSF resembles GBS with cytoalbuminological dissociation. Axonal polyradiculoneuropathy on electrodiagnostic testing.* HIVGBS more common in HIV patients; occurs at seroconversion. Demyelinating polyradiculoneuropathy on electrodiagnostic testing. CSF pleocytosis* CMV polyradiculopathyAIDS patient, late stages. Rapidly progressive lower extremity weakness and pain (sparing upper extremities). CSF pleocytosis. Axonal polyradiculopathy on electrodiagnostic testing.* PoliomyelitisEndemic area; sore throat, fever, nausea, vomiting, headache, acute-onset lower motor neuronopathy with myalgias and fasciculations. CSF pleocytosis. Lower motor neuronopathy on electrodiagnostic testing.* Critical illness myopathy & polyneuropathyQuadriparesis in critical care patients. Unremarkable CSF. Myopathic and/or axonal neuropathic features on electrodiagnostic testing.
Guillian Barre syndrome
Periodic paralysis
Poliomyelitis
Spinal cord compression
Miscellaneous