Question

Patient with ascending polyneuropathy after a recent GI or respiratory infection. Dx? Pathology? LP findings?

a) Guillain-Barré syndrome; Pathology: Demyelination; LP findings: Elevated protein with normal cell count
b) Multiple sclerosis; Pathology: Demyelination; LP findings: Oligoclonal bands
c) Chronic inflammatory demyelinating polyneuropathy (CIDP); Pathology: Axonal and demyelinating changes; LP findings: Elevated protein with normal cell count
d) Myasthenia gravis; Pathology: Autoimmune neuromuscular junction disorder; LP findings: Normal protein and cell count

Answer 1

A patient with ascending polyneuropathy after a recent GI or respiratory infection is likely diagnosed with Guillain-Barré syndrome, a demyelinating disease (option a). Lumbar puncture will show elevated protein levels with a normal white cell count, confirming the diagnosis.

Step-by-step explanation:

A patient presenting with ascending polyneuropathy following a recent GI or respiratory infection is likely to be diagnosed with Guillain-Barré syndrome (GBS). The pathology of GBS involves demyelination due to an autoimmune reaction, often triggered by preceding infections such as Campylobacter jejuni or various viral pathogens. Lumbar puncture (LP) findings in GBS typically show elevated protein levels with a normal cell count, indicating a disruption of nerve conduction without a corresponding increase in immune cells.

Pathology of Guillain-Barré Syndrome

Guillain-Barré syndrome is a demyelinating disease of the peripheral nervous system. It leads to sensations of tingling and weakness, which can progress to severe paralysis. The condition is an autoimmune response, where the body's immune system mistakenly attacks the myelin sheath around peripheral nerves. The loss of myelin sheath disrupts normal signal conduction.

Lumbar Puncture Findings in Guillain-Barré Syndrome

Diagnosis is supported by characteristic LP findings which include the presence of elevated protein levels that reflect nerve damage, while maintaining a normal white cell count, helping to distinguish it from infectious causes which typically raise the cell count. This protein elevation with relative absence of immune cells is indicative of the syndrome.

Hence, the answer is option a.

Answer 2

C. Chronic inflammatory demyelinating polyneuropathy (CIDP); Pathology: Axonal and demyelinating changes; LP findings: Elevated protein with normal cell count

Explanation:

The patient's presentation aligns closely with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP).

This condition often follows a GI or respiratory infection and exhibits a pattern of both axonal and demyelinating changes in nerve fibers. In CIDP, the cerebrospinal fluid analysis typically shows elevated protein levels with a normal cell count, which is a distinctive feature differentiating it from other neurologic conditions.

This disorder involves the immune system attacking the myelin sheath surrounding nerves, leading to progressive weakness and sensory deficits. The history of a recent infection and the characteristic CSF findings strongly support the diagnosis of CIDP in this case.