A 32-year-old patient presents to the emergency department with progressive muscle weakness in both legs, which began three days ago and is now affecting their arms. The patient reports a recent upper respiratory infection. Which of the following is the most likely diagnosis?
Multiple sclerosis
Guillain-Barré syndrome
Myasthenia gravis
Spinal cord compression
Guillain-Barré syndrome (GBS) is the correct answer. GBS is an acute inflammatory demyelinating polyneuropathy that typically presents with ascending paralysis, often beginning in the legs and progressing upwards. The patient's history of recent infection (in this case, upper respiratory) is a common trigger for GBS. The progressive nature of the weakness over days is characteristic of GBS.
Multiple sclerosis typically presents with visual disturbances, sensory changes, or focal neurological deficits rather than symmetric ascending weakness. Myasthenia gravis usually affects ocular and bulbar muscles first, causing drooping eyelids or difficulty swallowing. Spinal cord compression would likely present with a more clearly defined sensory level and may include bowel or bladder dysfunction.
Emergency nurses should be aware that GBS can progress rapidly and may lead to respiratory failure, requiring close monitoring and potential ICU admission.
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