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Answer 2
  1. Guillain-Barré syndrome. This patient has a rapidly progressing ascending motor disorder, characterized by weakness in the legs more than in the arms, mild facial weakness, areflexia, and vibration loss in a stocking distribution. An antecedent viral infection occurred 3 weeks ago. Acute inflammatory demyelinating polyneuropathy, also known as Guillain-Barré syndrome (GBS), is the most common cause of acute nontraumatic generalized paralysis. GBS has an annual incidence of 1.2 cases per 100,000 and affects every age group. A recent febrile illness can be identified in more than 60% of patients. The lower extremities are usually involved initially, followed by the upper extremities. More than 50% of patients with GBS have involvement of facial and other cranial muscles (eg, oropharyngeal, oculomotor). Although GBS primarily involves motor nerves, sensory symptoms and signs (eg, distal paresthesias, mild vibration, proprioception deficits) are not uncommon.

     Pascuzzi RM, Fleck JD. Acute peripheral neuropathy in adults. Guillain-Barré syndrome and related disorders. Neurol Clin 1997;15:529-47.

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