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What are the CSF protein levels in Guillain-Barré syndrome (GBS)?

Elevated or rising protein levels on serial lumbar punctures and 10 or fewer mononuclear cells/mm3 strongly support the diagnosis. A normal CSF protein level does not rule out GBS, however, as the level may remain normal in 10% of patients. CSF protein may not rise until 1-2 weeks after the onset of weakness.

What are the classic findings in CSF analysis of GBS?

The classic finding is albuminocytologic dissociation (elevated protein, despite normal cell count). Protein is usually elevated, up to very high levels (100-1,000 mg/dL) Elevated protein has a sensitivity of ~50% during the first week, but this increases over time (to ~80% by 3-4 weeks). Normal CSF analysis doesn't exclude GBS.

What is a normal CSF count in GBS?

Normal CSF analysis doesn't exclude GBS. Cell count is generally normal in GBS (<5 cells/uL), or at the most mildly elevated (<50 cells/uL). Elevated cell count >50 or increased neutrophils in CSF suggest an alternative diagnosis (e.g., HIV, Lyme, leptomeningeal carcinomatosis, or sarcoidosis).

How is Guillain-Barré syndrome (GBS) diagnosed?

Diagnosis of GBS depends on repeated neurologic examinations demonstrating a classic pattern of advancing, symmetrical motor weakness and diminished myotatic reflexes. Specific changes in cerebrospinal fluid (CSF) measurements and nerve conduction studies are strongly supportive of the diagnosis ( Table 1 2 – 9 ).


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