A 24-year-old woman presents with foot and leg weakness that is progressively getting worse over the past 1 week. Initially, she developed tingling in her feet and noticed that they would drag, but now she has difficulty standing and walking due to the leg weakness. Three weeks ago she had a "chest cold," which resolved on its own. On examination, muscle bulk is normal, motor strength is 2 out of 5 in the quadriceps, and 1 out of 5 in the feet. Reflexes at the ankle and knee are absent, and sensation testing is normal. The upper limb examination is normal. The CSF protein is very high, glucose is normal, and cell count is slightly elevated. Which of the following is the most likely diagnosis?
High-Yield Explanation
Guillain-Barre syndrome often appears days to weeks after a viral upper respiratory or gastrointestinal (GI) infection. The initial symptoms are due to symmetric limb weakness. Paresthesia may be present. Unlike most other neuropathies, proximal muscles may be affected more than distal muscles early in the disease. Tendon reflexes are usually lost within a few days. Protein content of the CSF is usually high within a few days of onset. Diabetic and alcoholic neuropathy do not have an acute onset type presentation as this patient did. Cyanide poisoning can cause paralysis, but it is generalized not just localized to the lower limbs.