Correct!
5. All the above
A spinal tap was performed which showed a normal opening pressure and pink clearing fluid. In tube 1 the white blood cell count was 1/HPF and protein 138 mg/dL (normal 15 to 45 mg/dL) MRI of the cervical spine was shown in Figure 3.
Figure 3. Representative view of the cervical MRI.
The neurology consultant was asked to perform electrophysiological studies, but declined. The consultant felt the patient was most likely suffering from acute spinal cord compression related to chronic spinal stenosis. The Intensivist felt that Guillain-Barré syndrome could not be entirely ruled out since prior MRI scans were not available, and hyporeflexia and dysautonomia are less common in acute spinal cord compression. Abuminocytological dissociation seen in the CSF was seen in about 70% of patients with GBS after the first 7 days of illness, but was non-specific. Guillain–Barré syndrome (GBS) was a rapid-onset autoimmune disease of the peripheral nervous system causing muscle weakness (1). During the acute phase, the disorder can be life-threatening with about 15% developing weakness of the breathing muscles requiring mechanical ventilation and some are affected by severe dysautonomia – a common cause of PEA arrest. Because of the autoimmune nature of GBS, treatment usually consists of intravenous immunoglobulin (IVIG) or plasmapheresis in addition to supportive therapy (1). Simultaneous GBS and cervical myelopathy have been previously reported (3). The patient was initially treated with IVIG for GBS, but after the MRI was obtained, this was discontinued and a decompressive laminectomy was performed the next day.
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