Guillain-Barré syndrome and acute flaccid paralysis: Viva

Branch 1: Making the diagnosis

A strong candidate recognises this as Guillain-Barré syndrome and applies the Brighton criteria. The diagnosis turns on the tempo, the symmetry, and the reflex pattern rather than on a single test. The child has a rapid onset of progressive, symmetrical, ascending flaccid weakness over days, with early areflexia and no sensory level, which is the classic clinical picture. The antecedent diarrhoeal illness points to Campylobacter jejuni and supports the diagnosis. A lumbar puncture for albuminocytological dissociation and neurophysiology to distinguish the demyelinating from the axonal subtypes are sent, but a normal early cerebrospinal fluid does not exclude the diagnosis, and treatment is started on the clinical picture. ^[2]