albuminocytologic dissociation

The dissociation is between the two things that usually rise together in CSF: in infection both protein and cells increase, whereas here protein rises alone. In Guillain-Barre syndrome the elevated protein reflects inflammation and increased permeability of the nerve roots at the blood-nerve barrier, while the absence of pleocytosis reflects an antibody-mediated rather than cell-rich process. The finding is often absent in the first week and becomes most reliable after about ten days, so a normal early CSF does not exclude the diagnosis. Importantly, a CSF white count above about fifty cells should prompt a search for an alternative diagnosis such as HIV seroconversion, Lyme disease, sarcoidosis, or leptomeningeal malignancy. Guillain-Barre typically follows Campylobacter jejuni enteritis and presents with ascending symmetric weakness and areflexia; management is IVIG or plasmapheresis with close monitoring of vital capacity, and corticosteroids are ineffective.