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INTRODUCTION

A systematic approach to evaluating neurologic symptoms includes localizing the problem anatomically and distinguishing peripheral disorders from those with a central etiology. Peripheral nerve disorders may affect sensory, motor, and autonomic functions (Table 146-1).

Table 146-1

Differentiating Central Nervous System from Peripheral Nervous System Disorders

GUILLAIN-BARRÉ SYNDROME

Clinical Features

Guillain-Barré syndrome (GBS) is an acute polyneuropathy characterized by immune-mediated peripheral nerve myelin sheath or axon destruction. It can be associated with a viral or febrile illness, Campylobacter jejuni infection, or vaccination.

Diagnosis and Differential

Although numerous variants exist, the typical presentation from GBS includes ascending symmetric weakness or paralysis and loss of deep tendon reflexes. Respiratory failure and significant autonomic fluctuations may occur. Cerebrospinal fluid (CSF) analysis typically shows high protein and a normal cell count (Table 146-2).

Table 146-2

Diagnostic Criteria for Classic Guillain-Barré Syndrome

Emergency Department Care and Disposition

  1. Initial treatment includes supportive care which may include respiratory support as the disease progresses.

  2. Consultation with a neurologist for admission to a monitored setting is recommended.

  3. Administration of IV immunoglobulin and plasmapheresis may shorten the time to recovery.

BELL'S PALSY

Clinical Features

Bell's palsy causes seventh cranial nerve dysfunction. Patients may complain of facial weakness, articulation problems, difficulty keeping an eye closed, or inability to keep food in the mouth on one side.

Diagnosis and Differential

Physical examination findings demonstrate weakness on one side of the ...

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