A 3-year-old unvaccinated child develops an ascending flaccid paralysis starting in the lower limbs over 2 days. CSF shows normal glucose, normal protein, and normal cells. Stool and throat swab are positive for poliovirus type 1. What feature DISTINGUISHES this from Guillain-Barré syndrome (GBS)?

• A Ascending nature of weakness
• B CSF albuminocytological dissociation absent (normal protein in polio) ✓
• C Fever preceding the paralysis
• D Bilateral symmetrical weakness

Explanation

The hallmark CSF finding that distinguishes poliomyelitis from GBS is that in polio, CSF protein is NORMAL (or mildly elevated) with a pleocytosis (polymorphonuclear initially, then mononuclear), while in GBS there is albuminocytological dissociation (elevated protein with normal or near-normal cell count). Ascending weakness occurs in both. Fever precedes both (post-infectious in GBS vs febrile paralytic illness in polio). Asymmetric weakness is more characteristic of polio, but both can have symmetric presentation initially.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.