Topic: Guillain-Barré syndrome
Subject: Medicine
A 43-year-old man presents 2 weeks after you see him for infectious diarrhea caused by C. jejuni. He has now developed bilateral proximal lower limb weakness and bilateral distal parasthesia and decreased ankle tendon reflex.
What is the most likely diagnosis?

Guillain-Barré syndrome is the most common acquired inflammatory neuropathy. It is an acute, usually rapidly progressive inflammatory polyneuropathy characterized by muscular weakness and mild distal sensory loss. In most patients, the syndrome begins 1-3 weeks after an infectious disorder, surgery, or vaccination. Infection is the trigger in > 50% of patients, common pathogens include Campylobacter jejuni, enteric viruses, herpesviruses, 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. Diagnosis is clinical. If Guillain-Barré syndrome is suspected, patients should be admitted to a hospital for electromyography (EMG), CSF analysis, and measurement of forced vital capacity. Guillain-Barré syndrome is a medical emergency, requiring constant monitoring and support of vital functions, typically in an ICU. Plasmapheresis helps when done early in the syndrome and is the treatment of choice in acutely ill patients. Immune globulin is also effective when given early.