In:
Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 100, No. 23 ( 2023-06-06), p. e2386-e2397
Kurzfassung:
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.
Materialart:
Online-Ressource
ISSN:
0028-3878
,
1526-632X
DOI:
10.1212/WNL.0000000000207282
Sprache:
Englisch
Verlag:
Ovid Technologies (Wolters Kluwer Health)
Publikationsdatum:
2023
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