The INCORRECT Statement is B: Deep Tendon Reflexes are Increased
Statement B is incorrect because deep tendon reflexes are characteristically decreased or absent in Guillain-Barré syndrome, not increased. This is a fundamental diagnostic feature of GBS and is explicitly listed as a required criterion for diagnosis 1.
Why Each Statement is Correct or Incorrect:
A) Autoimmune Post-Infectious Disease - CORRECT
GBS is indeed an autoimmune condition triggered by preceding infections. Approximately two-thirds of patients report symptoms of infection in the 6 weeks before onset 1. The most commonly identified antecedent pathogens include Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus, and Mycoplasma pneumoniae 2. The mechanism involves molecular mimicry, where immune responses against infectious organisms cross-react with peripheral nerve components 2.
B) Deep Tendon Reflexes are Increased - INCORRECT
This is the false statement. Reflexes are decreased or absent in most patients at presentation and in almost all patients at nadir 1. The diagnostic criteria explicitly state that "absent or decreased tendon reflexes in affected limbs" is a required feature for diagnosis 1.
Important caveat: In rare atypical cases (particularly the pure motor variant with acute motor axonal neuropathy subtype), normal or even exaggerated reflexes might be observed throughout the disease course 1. However, this represents a minority of patients (~10%) 3, and the classic presentation—which this clinical scenario describes—features hyporeflexia or areflexia.
C) CSF Protein Elevated, Cell Count Normal - CORRECT
The classic finding is albumino-cytological dissociation: elevated CSF protein with normal cell count 1. However, protein levels are normal in 30-50% of patients in the first week and 10-30% in the second week, so normal protein doesn't rule out GBS 1. Marked pleocytosis (>50 cells/μl) suggests alternative diagnoses 1.
D) Can Lead to Respiratory Failure - CORRECT
Respiratory failure is a serious complication of GBS. The disease can progress to involve respiratory muscles, requiring intensive care and ventilatory support 2. This is why monitoring is critical (see below).
E) Regular Monitoring of Vital Capacity Required - CORRECT
Regular monitoring of vital capacity is essential in GBS management to detect impending respiratory failure early. This allows for timely intervention with mechanical ventilation when needed. The management of severely paralyzed patients includes intensive care with ventilatory support 2.
Clinical Pearls:
Reflexes as a diagnostic anchor: The presence of increased reflexes should prompt consideration of alternative diagnoses such as spinal cord pathology, which is listed as a feature that casts doubt on GBS diagnosis (specifically "hyper-reflexia or clonus") 1
Progressive weakness pattern: The classic presentation involves distal paresthesias followed by weakness starting in legs, progressing to arms and cranial muscles over days to 4 weeks (usually <2 weeks) 1
Timing matters: This patient's presentation "a few weeks after" gastrointestinal infection fits the typical temporal relationship with antecedent infection 1