The CNS in Guillain-Barre Syndrome

Abstract

Guillain-Barré syndrome (GBS) and Fisher's variant, in particular, continue to provide stimulating challenges for semiologists. Because most neurologists were trained to believe that neurologic signs have intrinsic localizing significance, the study by Meienberg and Ryffel on page 402 in this issue seems to strengthen an assumption that the CNS must be affected in GBS. However, purists insist that Fisher's syndrome is simply a variant of GBS and that pathologic changes in GBS are found solely in peripheral nerves. Hence, each of the signs consistent with brain-stem involvement must also occur with peripheral nerve disease. To oppose what seems an obvious conclusion in favor of CNS involvement requires an explanation, based on peripheral mechanisms, for each of the neurologic signs described by Meienberg and Ryffel, as well as for the ataxia typical of Fisher's syndrome. Evidence that dysfunction of peripheral mechanisms may simulate brain-stem signs turns out to