A database study looks at clinical characteristics, GBS subtypes, and disease course in relation to CSF albuminocytologic dissociation and protein levels.

Guillain-Barré syndrome (GBS) is diagnosed on the basis of clinical findings, neurophysiologic studies, and cerebrospinal fluid (CSF) examination. Albuminocytologic dissociation (ACD; high protein level but normal cell count in CSF), which is common in patients with GBS, is currently used as a diagnostic criterion, but its value has been debated and a strict definition is lacking. High CSF total protein, which is also common in patients with GBS, has been related to late performance of lumbar puncture, sensorimotor variant, and a demyelinating nerve conduction study subtype. The objective of this study was to investigate the associations of findings in CSF, electrodiagnostic subtypes, severity, and outcome in 1500 patients in the International GBS Outcome Study.

ACD was present in 846 patients (70%) and increased with time from weakness onset to lumbar puncture: 4 days, 57%; >4 days, 84%. High CSF protein levels were associated with demyelinating subtype, proximal or global muscle weakness, and reduced ability to run at week 2 and week 4. Patients with Miller Fisher syndrome, distal weakness, and normal or equivocal nerve conduction studies frequently had lower CSF proteins. CSF cell count was <5 cells in 1005 patients (83%), 5 to 49 cells in 200 patients (16%), and ≥50 cells in 13 patients (1%).

Comment

These findings confirm that albuminocytologic dissociation is commonly seen in patients with GBS but show that normal protein levels do not exclude GBS. They also show that a high CSF protein level is frequently associated with an early severe course of the disease and a demyelinating subtype. Finally, elevated CSF cell count can be seen in some patients with GBS, although other diagnoses must first be excluded. GBS should still be considered even when protein levels are normal in the early period of disease (especially at 4 days or less from weakness onset), and some GBS patients (17%) have a CSF pleocytosis.