Cytological Features of Cerebrospinal Fluid in Guillain-Barré Syndrome and Their Diagnostic Value

  Objective  To investigate the cytological features of cerebrospinal fluid (CSF) in Guillain-Barré syndrome (GBS) and the role of the cytological features in the diagnosis of GBS.

  Methods  We reviewed the clinical, neurophysiological, and CSF cytological findings of GBS patients treated in Peking Union Medical College Hospital from January 2010 to December 2012. The included patients all met the diagnostic criteria in 2010 China Guidelines for Diagnosis and Treatment of GBS. CSF cytological tests were performed using sedimentation chamber and MGG staining. CSF routine cell count and CSF cytological-finding positive-rate were compared with Chi-square test.

  Results  Twenty-eight cases of GBS were included, at a mean age of 39 years (8-69 years), including 19 males and 9 females. The 28 patients all had acute onset, with 22 demonstrating limb weakness, 13 hypoesthesia, 3 hyperesthesia, 7 bulbar paralysis, 3 with the need of assisted ventilation, 5 urinary retention, 1 positional hypotension, 5 ophthalmoplegia, 10 facial paralysis, and 4 ataxia. The patients were clinically classified to acute inflammatory demyelinating polyneuropathy (20 cases), acute motor axonal neuropathy(1 case), acute motor-sensory axonal neuropathy (1 case), acute sensory neuropathy (1 case), Miller Fisher syndrome (4 cases), and GQ1b antibody-positive ophthalmoplegia (1 case). CSF protein was 0.39-4.23 g/L, increased in 26 cases, and >1.0 g/L in 11 cases. CSF white blood cell count was 0×10⁶-5×10⁶/L in 26 cases, and 6×10⁶-10×10⁶/L in 2 cases. Oligoclonal band test of CSF produced positive results in 14 cases, and myelin basic protein was found increased in 18. Anti-GM1 antibodies were positive in 3 cases and anti-GQ1b antibodies in 2 cases. Abnormal CSF cytological results were found in 12 patients, including lymphocytic inflammation in 9 and monocyte-lymphocytic inflammation in 3. The percentage of neutrophils reached 2% in 1 case. Activated lymphocytes were present in 6 cases, activated mononuclear macrophages in 2, and plasma cells in 3. The CSF cell count was over 5/μl in 2 patients (7.1%), significantly lower than the positive rate of CSF cytological test (12 cases, 42.9%, P < 0.01).

  Conclusions  CSF cytological test in GBS could detect inflammatory changes such as lymphocyte inflammation, consistent with the pathological mechanism of polyradiculitis in GBS. Compared with CSF routine cell count, cytological test is more sensitive in revealing the inflammatory status of CSF, showing larger diagnostic value for GBS.