Answer to question of the day: Neurological exam

We had some great input and debate from students on this question of the day from a nero exam. Congrats to those of you who correctly guessed it as Guillain Barre Syndrome.

Now check your hypothesis against the clinical signs:

Tone Any sign of UMN lesion or hypotonia (cerebellar?) NO

But there is some reduced tone in the left arm:

Power He is weak and its come on
over the past few days: this is classical of GBS: an ascending peripheral
motor and sensory poylneuropathy.
Coordination Normal: as expected
Sensation Normal: So can it still be
GBS???

YES! The sensory signs are often vary vague: there may be only back
pain as the presenting feature.

Reflexes Clinical tip: no reflexes
Auggests a lower motor neurone problem. Could it me MND? Very unlikely:
there’s only LMN signs and the onset of the illness is too acute.
Other things GBS: measure the Forced Vital Capacity:

If this is low: the patient may need ventilation.

Also remember: cardiac conduction deficits (monitor the patient on
a cardiac monitor)

Remember FVC monitoring in GBS.

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