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Gram stain positive CSF
23%
97/413
Peripheral eosinophilia
10%
43/413
Xanthochromia on cerebrospinal fluid analysis
8%
34/413
Increased cerebrospinal fluid protein with normal cell count
39%
162/413
Oligoclonal bands on cerebrospinal fluid analysis
11%
44/413
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This child with diarrhea and fever followed by lower extremity weakness and hyporeflexia has Guillain-Barre syndrome (GBS) after gastrointestinal illness. Cerebrospinal fluid (CSF) will show increased cerebrospinal fluid protein with normal cell count (albuminocytologic dissociation). GBS is an acute immune-mediated polyneuropathy thought to be caused by immune attack of peripheral Schwann cells and myelin via molecular mimicry induced by certain infectious antigens. Symmetric weakness primarily involving the motor fibers begins in the distal extremities and moves proximally. Increased CSF protein with a normal cell count (albuminocytologic dissociation) is typical of GBS. Incorrect Answers: Answer 1: Gram stain positive CSF would be expected in a bacterial meningitis. While this patient’s high fever is concerning for infection, he does not have signs of meningeal irritations such as headache and nuchal rigidity. His lower extremity weakness is more consistent with GBS as a result of a bacterial infection. Answer 2: In patients with a suspected infection, peripheral eosinophilia would point towards a parasitic source. While there are isolated reports of parasitic infections leading to GBS, this association is very rare and Campylobacter infection is more likely in this case. Answer 3: Xanthochromia is caused by breakdown of RBCs in the CSF and would be expected following a subarachnoid hemorrhage. Answer 5: Oligoclonal bands are seen in patients with multiple sclerosis and are not typically present in GBS. Bullet Summary: Analysis of cerebrospinal fluid in Guillain-Barre syndrome will show albuminocytologic dissociation.
4.8
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