In Guillain-Barré syndrome, the cerebrospinal fluid typically demonstrates which of the following patterns?

• A. Elevated white blood cell count with normal protein and glucose
• B. Low protein with low glucose
• C. Normal white blood cell count with highly elevated protein and normal glucose
• D. Normal white blood cell count with highly elevated protein and normal glucose

Answer: (D)

Guillain-Barré syndrome typically shows albuminocytologic dissociation in CSF: a markedly elevated protein concentration with a normal white blood cell count and normal glucose. This happens because immune-mediated demyelination of peripheral nerves increases protein in the CSF, but there isn’t a primary infection of the meninges, so inflammatory cells don’t accumulate and glucose isn’t consumed. Keep in mind that early in the illness the protein may still be normal, but as the process evolves, protein rises while the WBC count stays normal. This pattern helps differentiate GBS from meningitis or other infectious processes, which often have high WBC and/or abnormal glucose.