A 9-year-old boy presents with a several day history of progressive arm and leg weakness. He has been well except for an upper respiratory infection two weeks ago. The patient is ale and oriented. On repeated examination, the hea rate varies between 60 and 140 beats/minute and the blood pressure varies between 90/60 and 140/90 mm Hg. Respirations are shallow with a rate of 50/minute. There is symmetric weakness of the face and all four extremities. Deep tendon reflexes are absent. Sensation is intact. The most likely diagnosis is:
Progressive, symmetric motor weakness, areflexia, and autonomic instability, with mild or absent sensory signs, are typical features of Guillain-Barre syndrome. Frequently there is a history of infection (often respiratory) in the several weeks preceding clinical onset of the syndrome. Suppoive evidence for the diagnosis includes elevation of cerebrospinal fluid protein concentration with a mild (10 or fewer cells/mL) mononuclear pleocytosis and slowing of nerve conduction velocities. Ref: Greenberg D.A., Aminoff M.J., Simon R.P. (2012). Chapter 10. Sensory Disorders. In D.A. Greenberg, M.J. Aminoff, R.P. Simon (Eds), Clinical Neurology, 8e.
Polymyositis
Myasthenia gravis
Transverse myelitis
Guillain-Barre syndrome