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Abstract
Background and Objectives To investigate CSF findings in relation to clinical and electrodiagnostic subtypes, severity, and outcome of Guillain-Barré syndrome (GBS) based on 1,500 patients in the International GBS Outcome Study.
Methods Albuminocytologic dissociation (ACD) was defined as an increased protein level (>0.45 g/L) in the absence of elevated white cell count (<50 cells/μL). We excluded 124 (8%) patients because of other diagnoses, protocol violation, or insufficient data. The CSF was examined in 1,231 patients (89%).
Results In 846 (70%) patients, CSF examination showed ACD, which increased with time from weakness onset: ≤4 days 57%, >4 days 84%. High CSF protein levels were associated with a demyelinating subtype, proximal or global muscle weakness, and a reduced likelihood of being able to run at week 2 (odds ratio [OR] 0.42, 95% CI 0.25–0.70; p = 0.001) and week 4 (OR 0.44, 95% CI 0.27–0.72; p = 0.001). Patients with the Miller Fisher syndrome, distal predominant weakness, and normal or equivocal nerve conduction studies were more likely to have lower CSF protein levels. CSF cell count was <5 cells/μL in 1,005 patients (83%), 5–49 cells/μL in 200 patients (16%), and ≥50 cells/μL in 13 patients (1%).
Discussion ACD is a common finding in GBS, but normal protein levels do not exclude this diagnosis. High CSF protein level is associated with an early severe disease course and a demyelinating subtype. Elevated CSF cell count, rarely ≥50 cells/μL, is compatible with GBS after a thorough exclusion of alternative diagnoses.
Classification of Evidence This study provides Class IV evidence that CSF ACD (defined by the Brighton Collaboration) is common in patients with GBS.
Glossary
- ACD=
- albuminocytologic dissociation;
- CSF-TP=
- CSF total protein;
- GBS=
- Guillain-Barré syndrome;
- GBS-DS=
- GBS disability score;
- Ig=
- immunoglobulin;
- IGOS=
- International GBS Outcome Study;
- IQR=
- interquartile range;
- LP=
- lumbar puncture;
- MFS=
- Miller Fisher syndrome;
- MRC=
- Medical Research Council;
- NCS=
- nerve conduction study;
- OR=
- odds ratio;
- PE=
- plasma exchange
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Dr. Gutiérrez-Gutiérrez is currently at the Universidad Europea de Madrid.
The Author Byline is continued at the end of the article.
Author affiliations appear at the end of the article.
Authors, their locations, and their contributions are listed at links.lww.com/WNL/C840.
Coinvestigators are listed at links.lww.com/WNL/C765.
Submitted and externally peer reviewed. The handling editor was Associate Editor Anthony Amato, MD, FAAN.
Editorial, page 1081
Class of Evidence: NPub.org/coe
CME Course: NPub.org/cmelist
- Received July 15, 2022.
- Accepted in final form February 27, 2023.
- © 2023 American Academy of Neurology
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