All of the following are features of Guillian-Barre syndrome except:
Ans: D (Bladder and bowel involvement) Ref: Harrison's Principles of Internal Medicine. 18th edition. 2012. Chapter 385. (Table 385-3)Explanation:Guiilian-Barre SyndromeGBS manifests as a rapidly evolving areflexic motor paralysis with or without sensory- disturbance.The usual pattern is an ascending paralysis that may be first noticed as rubbery legs. Weakness typically evolves over hours to a few days and is frequently accompanied by tingling dysesthesias in the extremities.The legs are usually more affected than the arms, and facial di pares is is present in 50%' of affected individuals.The lower cranial nerves are also frequently- involved. causing bulbar weakness with difficulty handling secretions and maintaining an airway; the diagnosis in these patients may initially he mistaken for brainstem ischemia.Pain in the neck, shoulder, back, or diffusely over the spine is also common in the early stages of GBS, occurring in 50% of patients.Most patients require hospitalization, and in different series upto 30% require ventilatory assistance at some time during the illness.Fever and constitutional symptoms are absent at the onset.Deep tendon reflexes attenuate or disappear within the first few days of onset.Cutaneous sensory deficits (e.g., loss of pain and temperature sensation) are usually relatively mild, but functions subserved by large sensory fibers, such as deep tendon reflexes and proprioception, are more severely affected.Bladder dysfunction may occur in severe cases hut is usually transient.If bladder dysfunction is a prominent feature and comes early in the course, diagnostic possibilities other than GBS should he considered, particularly spinal cord disease.Once clinical worsening stops and the patient reaches a plateau (almost always within 4 weeks of onset), further progression is unlikely.Autonomic involvement is common and may occur even in patients whose GBS is otherwise mild.The usual manifestations are loss of vasomotor control with wide fluctuation in blood pressure, postural hypotension and cardiac dysrhythmias.Pain is another common feature of GBS; in addition to the acute pain described above, a deep aching pain may be present in w eakened muscles that patients like to having overexercised the previous day.Other pains in GBS include dysesthetic pain in the extremities as a manifestation of sensory nerve fiber involvement. These pains are selflimited and often respond to standard analgesics.
Predominant motor involvement
Facial nerve involvement
Absence of pleocytosis in CSF
Bladder and bowel involvement
Peripheral Nerve & Muscles