Case study Twenty one years old John presented with complaining of a two-day history of mild weakness in his lower limbs and a recent tendency to trip when walking. He said that about two weeks ago, he had the “flu” with a running nose and a cough and had felt cold. He had not seen a doctor and only took OTC medication.
On the examination, he had abnormal gait with loss of planar flexion, and a marked decrease in his ability to dorsiflex, invert and evert his feet. He had loss of sensation to deep pressure in his feet and decrease deep tendon reflexes at the ankle and knee. The strength in his quadriceps was reduced with a score of 3/5. Further examination demonstrated loss of position sense below mid-calf, and between sharp and blunt objects. Sensation, movement and strength were normal in his trunk and arms. No speech and swallowing deficits, breathing difficulties or cardiac arrhythmias were present at this time.
Following admission, John was monitored for progression of the paralysis, cardiac irregularities and respiratory function. Progression of his symptoms continued with loss of quadriceps strength and tendon reflexes. Cardiac monitoring showed sinus rhythm; his respiratory rate and depth, vital capacity and pulse oximetry remained within normal limits. An examination of cerebrospinal fluid (CSF) revealed an increase in protein and normal white cell count. Based on the information, a diagnosis of Guillain–Barré syndrome was made.
Questions to answer:
1. What is the pathophysiology of this disease?
2. Explain about the management of this disease including diagnostic investigation and drug therapy.

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