CSF Findings in Relation to Clinical Characteristics, Subtype, and Disease Course in Patients With Guillain-Barre Syndrome

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Autores de IDIVAL

Autores ajenos al IDIVAL

  • Al-Hakem H
  • Doets AY
  • Stino AM
  • Zivkovic SA
  • Andersen H
  • Willison HJ
  • Cornblath DR
  • Gorson KC
  • Islam Z
  • Mohammad QD
  • Sindrup SH
  • Kusunoki S
  • Davidson A
  • Casasnovas C
  • Bateman K
  • Miller JA
  • van den Berg B
  • Verboon C
  • Roodbol J
  • Leonhard SE
  • Arends S
  • Luijten LWG
  • Benedetti L
  • Kuwabara S
  • Van den Bergh P
  • Monges S
  • Marfia GA
  • Shahrizaila N
  • Galassi G
  • Pereon Y
  • Bürmann J
  • Kuitwaard K
  • Kleyweg RP
  • Marchesoni C
  • Querol L
  • Martín-Aguilar L
  • Wang Y
  • Nobile-Orazio E
  • Rinaldi S
  • Schenone A
  • Pardo J
  • Vermeij FH
  • Waheed W
  • Lehmann HC
  • Granit V
  • Stein B
  • Cavaletti G
  • Gutiérrez-Gutiérrez G
  • Barroso FA
  • Visser LH
  • Katzberg HD
  • Dardiotis E
  • Attarian S
  • van der Kooi AJ
  • Eftimov F
  • Wirtz PW
  • Pa Samijn J
  • Gilhuis HJ
  • Dm Hadden R
  • Holt JK
  • Sheikh KA
  • Kolb N
  • Karafiath S
  • Vytopil M
  • Antonini G
  • Feasby TE
  • Faber C
  • Kramers H
  • Busby M
  • Roberts RC
  • Silvestri NJ
  • Fazio R
  • van Dijk GW
  • Garssen MP
  • Verschuuren J
  • Harbo T
  • Jacobs BC

Unidades

Abstract

Background and ObjectivesTo investigate CSF findings in relation to clinical and electrodiagnostic subtypes, severity, and outcome of Guillain-Barre syndrome (GBS) based on 1,500 patients in the International GBS Outcome Study.MethodsAlbuminocytologic dissociation (ACD) was defined as an increased protein level (>0.45 g/L) in the absence of elevated white cell count (<50 cells/& mu;L). We excluded 124 (8%) patients because of other diagnoses, protocol violation, or insufficient data. The CSF was examined in 1,231 patients (89%).ResultsIn 846 (70%) patients, CSF examination showed ACD, which increased with time from weakness onset: & LE;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/& mu;L in 1,005 patients (83%), 5-49 cells/& mu;L in 200 patients (16%), and & GE;50 cells/& mu;L in 13 patients (1%).DiscussionACD 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 & GE;50 cells/& mu;L, is compatible with GBS after a thorough exclusion of alternative diagnoses.Classification of EvidenceThis study provides Class IV evidence that CSF ACD (defined by the Brighton Collaboration) is common in patients with GBS.

© 2023 American Academy of Neurology.

Datos de la publicación

ISSN/ISSNe:
0028-3878, 1526-632X

NEUROLOGY  LIPPINCOTT WILLIAMS & WILKINS

Tipo:
Article
Páginas:
2386-2397
PubMed:
37076309

Citas Recibidas en Web of Science: 20

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