Topic: Guillain-Barr� syndrome
Subject: Medicine
Guillain-Barr� syndrome is not associated with which of the following?
Proximal muscle weakness
Areflexia
Infection with C. jejuni
Treatment with corticosteroids
Correct Answer :
D. Treatment with corticosteroids
Guillain-Barr� syndrome is an acute, usually rapidly progressive inflammatory polyneuropathy characterized by muscular weakness and mild distal sensory loss. Cause is thought to be autoimmune. In about 2/3 of patients, the syndrome begins 5 days to 3 weeks after an infectious disorder, surgery, or vaccination. Infection is the trigger in > 50% of patients; common pathogens include Campylobacter jejuni, enteric viruses, herpesviruses (including cytomegalovirus and those causing infectious mononucleosis), and Mycoplasma. Flaccid weakness predominates in most patients; it is always more prominent than sensory abnormalities and may be most prominent proximally. Relatively symmetric weakness with paresthesias usually begins in the legs and progresses to the arms, but it occasionally begins in the arms or head. In 90% of patients, weakness is maximal at 3 weeks. Deep tendon reflexes are lost. Sphincters are usually spared. Facial and oropharyngeal muscles are weak in > 50% of patients with severe disease. Respiratory paralysis severe enough to require endotracheal intubation and mechanical ventilation occurs in 5 to 10%. Diagnosis is clinical. Treatment includes plasmapheresis, IVIg, and, for severe cases, mechanical ventilation. Corticosteroids (oral or IV) have not been found to have a clinical benefit.
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