As Pune reports over 110 suspected cases of Guillain-Barré syndrome, doctors explain why cerebrospinal fluid examination is done

Dr Pawan Ojha, director of neurology at Fortis Hiranandani Hospital, Vashi, said that it is a “neurological emergency” disorder characterised by the sudden onslaught of weakness in the hands or legs and sometimes difficulty in eye movements, and in swallowing and speaking.

“It can lead to sudden breathing difficulties. Many patients first experience weakness in the hands or legs, but within a day or two, they cannot sit or turn in bed. Few of them become so weak that they are unable to swallow or even breathe. The condition can be so rapid that they can go on a ventilator for breathing support within a day or so. However, most cases are not rapid and take about 4-5 days to develop such symptoms,” said Dr Ojha.

Why does it occur?

It is an immunological reaction of the body to any infection, such as viral or sometimes bacterial, said Dr Ojha. “It attacks the immune system by damaging our nerves instead of targetting the virus or bacteria. This happens due to the molecular mimicry mechanism. So, the nerves start to become weak and are unable to function,” said Dr Ojha.

Why is cerebrospinal fluid (CSF) examination done?

Cerebrospinal fluid (CSF) examination is essential for diagnosing various neurological diseases, said consultant neurologist Dr Sudhir Kumar, Apollo Hospitals, Hyderabad. “These include central nervous system infections, such as meningitis and encephalitis. In GBS, the CSF examination shows elevated protein, with normal or slightly raised CSF white blood cell (WBC) counts. GBS is usually a post-infectious (usually post viral) neurological illness, which results in paralysis of arms and legs,” said Dr Kumar.

Here’s why the examination is done (Photo: Freepik)

Spinal examination is carried out by doing a lumbar puncture, said Dr Ojha. “The idea is to confirm if it is GBS. In GBS, one tends to have excess proteins in the spinal fluid and an abnormal white blood cell count in the examination. It is an auxiliary test,” said Dr Ojha.

What else to note?

According to a September 2019 Nature Neurology review, CSF examination mainly rules out causes of weakness other than GBS. It should be performed during the initial evaluation of the patient. It noted that the “classic finding” in GBS combines an elevated CSF protein level and a normal CSF cell count (albumino-cytological dissociation).

“However, protein levels are normal in 30–50 per cent of patients in the first week after disease onset and 10–30 per cent in the second week. Therefore, normal CSF protein levels do not rule out a diagnosis of GBS,” it read.

Treatment

Treatment consists of immunotherapy, such as intravenous immunoglobulin (IVIG) or plasma exchange, to reduce nerve damage caused by the immune attack, said Dr Agarwal. “Recovery will depend on person to person and a large number of them will gain their mobility back within 3-4 weeks or months, while some may notice symptoms for some months,” said Dr Agarwal.

DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.