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Answer 3
  1. Lumbar puncture. Most patients with GBS develop an abnormal spinal fluid profile within the first week of illness, with elevated cerebrospinal fluid protein in the absence of pleocytosis (albuminocytologic dissociation). Patients with GBS who have a lymphocytic pleocytosis should be evaluated for coexistent HIV infection, Lyme disease, or sarcoidosis. Electromyography and nerve conduction studies are useful to demonstrate the presence of a demyelinating polyneuropathy with reduced conduction velocities and temporally dispersed compound muscle action potentials. These abnormalities may be delayed for 10 to 14 days; however, prolonged long-latency F waves, a measure of spinal root integrity, may be found early in the disease course. Neuroimaging of the brain or spine is not usually warranted in patients with GBS. Serum creatine kinase and Tensilon (edrophonium) testing are useful in the diagnostic evaluation of myopathy and myasthenia gravis, respectively.

     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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