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

被引：24

作者：

Al-Hakem, Helle ^{[1
]}

Doets, Alex Y. ^{[2
]}

Stino, Amro Maher ^{[3
]}

Zivkovic, Sasha A. ^{[4
]}

Andersen, Henning ^{[1
]}

Willison, Hugh J. ^{[5
]}

Cornblath, David R. ^{[6
]}

Gorson, Kenneth C. ^{[7
]}

Islam, Zhahirul ^{[8
,9
]}

Mohammad, Quazi Deen ^{[10
]}

Sindrup, Soren Hein ^{[11
,12
]}

Kusunoki, Susumu ^{[13
]}

Davidson, Amy ^{[5
]}

Casasnovas, Carlos ^{[14
]}

Bateman, Kathleen ^{[15
]}

Miller, James A. L. ^{[16
]}

van den Berg, Bianca ^{[2
,17
]}

Verboon, Christine ^{[2
]}

Roodbol, Joyce ^{[2
]}

Leonhard, Sonja E. ^{[2
]}

Arends, Samuel ^{[2
,18
]}

Luijten, Linda W. G. ^{[2
,19
]}

Benedetti, Luana ^{[20
]}

Kuwabara, Satoshi ^{[21
]}

van den Bergh, Peter ^{[22
]}

Monges, Soledad ^{[23
,24
]}

Marfia, Girolama A. ^{[25
]}

Shahrizaila, Nortina ^{[26
]}

Galassi, Giuliana ^{[27
]}

Pereon, Yann ^{[28
]}

Burmann, Jan ^{[29
,30
]}

Kuitwaard, Krista ^{[2
,31
]}

Kleyweg, Ruud P. ^{[31
]}

Marchesoni, Cintia ^{[32
]}

Tous, Maria J. Sedano ^{[33
]}

Querol, Luis ^{[34
]}

Martin-Aguilar, Lorena ^{[34
]}

Wang, Yuzhong ^{[35
]}

Nobile-Orazio, Eduardo ^{[36
]}

Rinaldi, Simon ^{[37
]}

Schenone, Angelo ^{[38
,39
]}

Pardo, Julio ^{[40
]}

Vermeij, Frederique H. ^{[41
]}

Waheed, Waqar ^{[42
]}

Lehmann, Helmar C. ^{[43
]}

Granit, Volkan ^{[44
]}

Stein, Beth ^{[44
]}

Cavaletti, Guido ^{[45
]}

Gutierrez-Gutierrez, Gerardo ^{[46
]}

Barroso, Fabio A. ^{[47
]}

机构：

[1] Aarhus Univ Hosp, Dept Neurol, Aarhus, Denmark

[2] Univ Med Ctr Rotterdam, Dept Neurol, Erasmus MC, Rotterdam, Netherlands

[3] Univ Michigan, Dept Neurol, Sch Med, Ann Arbor, MI USA

[4] Univ Pittsburgh, Dept Neurol, Med Ctr, Pittsburgh, PA USA

[5] Univ Glasgow, Coll Med Vet & Life Sci, Dept Neurol, Glasgow, Scotland

[6] Johns Hopkins Univ, Dept Neurol, Sch Med, Baltimore, MD USA

[7] Tufts Univ, St Elizabeths Med Ctr, Sch Med, Dept Neurol, Boston, MA USA

[8] Natl Inst Neurosci & Hosp, Lab Gut Brain Signaling, Dhaka, Bangladesh

[9] Natl Inst Neurosci & Hosp, Lab Sci & Serv Div LSSD, Dhaka, Bangladesh

[10] Natl Inst Neurosci & Hosp, Dhaka, Bangladesh

[11] Odense Univ Hosp, Dept Neurol, Odense, Denmark

[12] Univ Southern Denmark, Odense, Denmark

[13] Kindai Univ, Dept Neurol, Fac Med, Osaka, Japan

[14] Bellvitge Univ Hosp, Dept Neurol, Neuromusc Unit, IDIBELL, Barcelona, Spain

[15] Univ Cape Town, Groote Schuur Hosp, Dept Med, Div Neurol, Cape Town, South Africa

[16] Newcastle Tyne Hosp NHS Fdn Trust, Royal Victoria Infirm, Dept Neurol, Newcastle Upon Tyne, England

[17] Franciscus Gasthuis & Vlietland, Dept Neurol, Schiedam, Netherlands

[18] Haga Hosp, Dept Neurol, The Hague, Netherlands

[19] St Elisabeth Twee Steden Hosp, Dept Neurol, Tilburg, Netherlands

[20] IRCCS Osped Policlin San Martino, Dept Neurol, Genoa, Italy

[21] Chiba Univ, Dept Neurol, Chuo Ku, Chiba, Japan

[22] Univ Louvain, Univ Hosp St Luc, Neuromuscular Reference Ctr, Dept Neurol, Brussels, Belgium

[23] Univ Louvain, Univ Hosp St Luc, Neuromusc Reference Ctr, Brussels, Belgium

[24] Hosp Pediatria JP Garrahan, Dept Neurol, Buenos Aires, Argentina

[25] Tor Vergata Univ Hosp, Dept Syst Med, Dysimmune Neuropathies Unit, Rome, Italy

[26] Univ Malaya, Dept Med, Kuala Lumpur, Malaysia

[27] Univ Hosp Modena, Dept Neurol, Modena, Italy

[28] CHU Nantes, Dept Clin Neurophysiol, Reference Ctr NMD, Nantes, France

[29] Saarland Univ Med Sch, Dept Neurol, Homburg, Germany

[30] MVZ Pfalzklinikum, Kusel, Germany

[31] Albert Schweitzer Hosp, Dept Neurol, Dordrecht, Netherlands

[32] Hosp Britan, Dept Neurol, Buenos Aires, Argentina

[33] Hosp Marques Valdecilla, Dept Neurol, Santander, Spain

[34] Univ Autonoma Barcelona, Hosp St Creu & St Pau, Dept Neurol, CIBERER, Madrid, Spain

[35] Jining Med Univ, Affiliated Hosp, Dept Neurol, Jining, Shandong, Peoples R China

[36] Milan Univ, IRCCS Humanitas Res Hosp, Neuromusc & Neuroimmunol Serv, Milan, Italy

[37] Univ Oxford, Nuffield Dept Clin Neurosci, Oxford, England

[38] Univ Genoa, Dept Neurosci Ophthalmol Rehabil Genet & Maternal, Genoa, Italy

[39] IRCCS San Martino Hosp, Genoa, Italy

[40] Hosp Clin Santiago, Dept Neurol, Santiago De Compostel, Spain

[41] Montefiore Med Ctr, Dept Neurol, Bronx, NY USA

[42] Univ Vermont Med Ctr, Dept Neurol, Burlington, VT USA

[43] Univ Hosp Cologne, Dept Neurol, Cologne, Germany

[44] Montefiore Med Ctr, Dept Neurol, Bronx, NY USA

[45] Univ Milano Bicocca, Dept Neurol, Monza, Italy

[46] Hosp Univ Infanta Sofia, Dept Neurol, San Sebastian Los Reyes, Spain

[47] Inst Invest Neurol Raul Carrea, Dept Neurol, FLENI, Buenos Aires, Argentina

[48] Univ Toronto, Univ Hlth Network, Dept Neurol, Toronto, ON, Canada

[49] Univ Hosp Larissa, Dept Neurol, Larisa, Greece

[50] CHU, Timone ERN NMD, Reference Ctr NMD, Dept Neurol, Marseille, France

来源：

NEUROLOGY | 2023年 / 100卷 / 23期

关键词：

CEREBROSPINAL-FLUID PROTEIN; DIAGNOSIS; CLASSIFICATION; VALIDATION; GUIDELINES; CRITERIA; ALBUMIN;

D O I：

10.1212/WNL.0000000000207282

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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.

引用

页码：E2386 / E2397

页数：12

共 37 条

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