What is the typical presentation of Guillain-Barré syndrome?

• A. Asymmetric descending spastic paralysis
• B. Localized weakness with hyperreflexia
• C. Pure sensory loss
• D. Symmetric progressive ascending flaccid paralysis

Answer: (D)

Guillain-Barré syndrome is an acute inflammatory problem of the peripheral nerves that famously causes weakness to begin in the legs and climb upward, often progressing to involve the arms and even respiratory muscles. The weakness is typically symmetric and accompanied by reduced or absent reflexes, reflecting a flaccid, lower motor neuron pattern rather than an upper motor neuron process. This combination of acute onset, symmetric ascending weakness, and flaccidity is the hallmark.

Why the other patterns don’t fit: an asymmetric descending spastic weakness points to a central nervous system lesion (for example, a brainstem or spinal cord problem) and would usually show hyperreflexia and spasticity. Localized weakness with hyperreflexia suggests an upper motor neuron issue rather than a diffuse peripheral neuropathy. Pure sensory loss implies loss of sensation with little or no weakness, which is not characteristic of Guillain-Barré, where motor involvement is prominent. Therefore, the presentation that best matches Guillain-Barré is symmetric progressive ascending flaccid paralysis.