A 50-year-old man presents to the emergency in a wheelchair complaining of weakness that has developed over the past 2 days. He first noticed that he had generalized fatigue and felt like he was having a hard time moving his feet. Over the past 24 hours, the weakness has progressed to the point that he can barely stand with assistance. He is beginning to feel that it is difficult to lift his arms. He also complains of a sharp pain in his shoulders and along his spine. Both his hands and feet are tingling. On physical examination, his initial blood pressure is 140/80 mmHg. On repeat 1 hour later, it is 90/50 mmHg. His hea rate is 106 bpm, respiratory rate is 25 breaths/min, temperature is 37.0degC, and SaO2 is 96% on room air. Deep tendon reflexes are absent at the knee, ankle, and wrist. The brachioradialis reflex is 1+. Strength throughout the lower extremities is diminished as the patient is unable to lift either leg against gravity. What is the appropriate diagnosis?
High-Yield Explanation
Choice A is ruled out as it presents with descending paralysis. Snake bite will have autonomic features and is unlikely that patient does not feel the pain Polio is ruled out as it has descending paralysis. Ascending paralysis, areflexia and sphincter sparing is feature of GBS GBS 1. Lumbar puncture analysis CSF opening pressure - Normal Cells - Normal Sugar - Normal Color- Normal Protein- Raised Albumino - cytological dissociation(Also seen in Froin's loculation Syndrome) 2. Nerve conduction velocity - F - Reflex - Latency period|3. MRI spine - Demyelination4. Antibody of G.B.S : Anti GM1 A/b Rx- I.V Immunoglobulin's - DOCPlasmapheresis - Efficacy of IV Ig & plasmapheresis is equal.