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Table 71.1

Clinical Assessment

History

Prodromal illness? Other potential trigger?

Backpain? Weakness? Sensory disturbance? Autonomic symptoms? Sphincter disturbance? Ataxia? Diplopia? Dysphagia? Dysarthria?

Onset? Progression? Fever? Rash? Ongoing systemic upset?

Prior episodes? Past history/comorbidities? HIV? Haematological malignancy? Tick bite? Alcohol excess? Poor diet? Travel? Toxin/heavy metal exposure? Drugs?

Red flags for alternative diagnosis?

Hyperacute onset? Marked fluctuation/fatigability? Sphincter disturbance at onset? Persistent bowel/bladder dysfunction? Progression greater than four weeks from onset? Neurological dysfunction developing concurrently with systemic upset?

Examination

Supportive findings:

  • Largely symmetrical, proximal and distal flaccid limb weakness.
  • Areflexia: bilateral facial palsy +/– other cranial nerve palsies; autonomic dysfunction.
Examination red flags for alternative diagnosis: marked asymmetry; upper motor neuron signs; sensory level; rash; fever; fatigable weakness.