Monday, December 29, 2008

Symmetric

A 30 year old female presents with symmetric weakness of the proximal legs. She also complains of mild paresthesias in the hands and feet and pain in the lower back. The only other remarkable thing is a recent viral illness. On exam, you find tachycardia and absent deep tendon reflexes. LP shows elevated CSF protein with a normal WBC count.

Challenge: What's the diagnosis?

3 comments:

Alex said...

guillomebarre?

CodeDog said...

Peripheral neuropathy caused by Guillain-Barré syndrome which in turn was triggered by the (now cleared) viral infection.

Elevated protein without elevated cell count counter indicates a continuing infection, pointing us toward an autoimmune disorder.

By the their conspicuous absence in the case history we must assume normal blood sugar (ruling out diabetic neuropathy) and a clean tox screen (ruling out alcoholism or heavy metal poisoning)

Craig Chen said...

nice!
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Symmetric

This is Guillain Barre syndrome, and the CSF finding is called albuminocytologic dissociation.

Source: UpToDate.