1. case Male,35years old,complained of weakness of four limbs for 1 day on admission.He had a cold 2 weeks before admission.the weakness became severe and lead to tetraplegia on the 3 day.Aphagia appeared almost the same time.Numbness of fingers and toes was mentioned.He had no difficulties on micturation. Male,35years old,complained of weakness of four limbs for 1 day on admission.He had a cold 2 weeks before admission.the weakness became severe and lead to tetraplegia on the 3 day.Aphagia appeared almost the same time.Numbness of fingers and toes was mentioned.He had no difficulties on micturation.

2. exam Cranial nerves:diminished elevation of palatal,gag reflex disappear Cranial nerves:diminished elevation of palatal,gag reflex disappear Motor system:muscle tension decreased; muscle force: 0 grade of all four limbs. Motor system:muscle tension decreased; muscle force: 0 grade of all four limbs. Sensory system:slightly stocking-glove type pain decreased. Sensory system:slightly stocking-glove type pain decreased. Reflex:areflexia.Babinski ’ s sign:(-). Reflex:areflexia.Babinski ’ s sign:(-). Others:normal. Others:normal.

3. Acute Inflammatory Demyelinating Polyneuropathy Guillain-Barre Syndrome zhao dongxue zhao dongxue

4. Etiology and Pathology Etiology: Etiology: unknown. unknown. cell-mediated immunologic reaction cell-mediated immunologic reaction Pathology: Pathology: Perivascular lymphocytic infiltrates Perivascular lymphocytic infiltrates Perivenous segmental demyelinating Perivenous segmental demyelinating

5. Clinical Features(I) Preceding infection: Preceding infection: Motor system:weakness of limbs Motor system:weakness of limbs symmetic and flaccid symmetic and flaccid respiratory failure respiratory failure

6. Clinical Features(II) Sensory system: Sensory system: stocking-glove type stocking-glove type

7. Clinical Features(III) Cranial nerves:facial diplegia. Cranial nerves:facial diplegia. bulbar palsy bulbar palsy others. others. Autonomic dysfunction:tachycardia Autonomic dysfunction:tachycardia labile blood pressure labile blood pressure disturbed sweating disturbed sweating Sphincter function:not involved usually Sphincter function:not involved usually

8. Laboratory Findings CSF:protein-cell dissociation on the third CSF:protein-cell dissociation on the third week week Electrophysiology:MCV and SCV slowed Electrophysiology:MCV and SCV slowed

9. Diagnosis Preceding Infection Preceding Infection Clinical Features Clinical Features Laboratory Findings Laboratory Findings

10. Differential Diagnosis Periodic paralysis Periodic paralysis Poliomyelitis Poliomyelitis Myasthenia Gravis Myasthenia Gravis

11. Treatment Symptomatic Treatmeat: Symptomatic Treatmeat: Etiologic Treatment: Etiologic Treatment: plasmaexchange plasmaexchange intravenous immunoglobulin intravenous immunoglobulin corticosteroid corticosteroid