Lower limb weakness and areflexia

A 52-year-old man, who was previously healthy, presented with weakness of both lower limbs, which was progressing over few days.

Examination revealed  decreased muscle power of the lower limbs with areflexia.

Which one of the following is more likely to be found at the time of presentation:

A- Urine incontinence

B- Sensory level

C- Increased polymorphonuclear cells in CSF

D- Increased protein concentration in CSF

E- Increased mononuclear cells in CSF

Check the answer below

The answer is D

The most likely diagnosis is Guillain-Barré syndrome, which is characterized by increased protein concentration in CSF with normal cell count (albumino-cytological dissociation).

Sphincter disturbance at presentation is not common, and if present it should raise the suspicion of an alternative diagnosis.

Sensory level is a feature of spinal cord lesion rather than neuropathy.