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GBS NINDS Diagnostic criteria

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GBS NINDS Diagnostic criteria:

Required

  • Progressive weakness of more than one limb

  • Areflexia (typically global, can be distal with preserved proximal reflexes)

Supportive features:

  • Progression of symptoms over days to four weeks

  • Relative symmetry

  • Mild sensory symptoms or signs

  • Cranial nerve involvement, especially bilateral facial nerve weakness

  • Recovery starting two to four weeks after progression halts

  • Autonomic dysfunction

  • No fever at the onset

  • Elevated protein in CSF (>45) with a cell count <10 mm3 (“cytoalbuminologic dissociation”)

  • Electro diagnostic abnormalities consistent with GBS

Features making diagnosis of GBS doubtful:

  • Sensory level (decrement or loss of sensation below a spinal cord root level as determined by neuralgic examination)

  • Marked, persistent asymmetry of weakness

  • Severe and persistent bowel and bladder dysfunction

  • 50 white cells in the CSF

  • The ddx of GBS includes other acute polyneuropathies, chronic inflammatory demyelinating polyneuropathy (CIDP), and diseases of the spinal cord, neuromuscular junction, and muscle; the ddx of the MFS variant of GBS includes brainstem stroke, encephalitis, Wernicke's encephalopathy