# Situation: A 38-year-old man is admitted to the neurology ward with Guillain-Barré syndrome (GBS). Leg weakness began 4 days ago and is spreading upward. He had diarrhea 2 weeks before. He weighs 70 kg and has no other illness. A lumbar puncture is done. Normal values: protein 15–45 mg/dL; white blood cells 0–5 cells/µL; glucose 50–80 mg/dL. Protein: 190 mg/dL White blood cells: 3 cells/µL Glucose: 64 mg/dL Which interpretation is correct?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630428  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 38-year-old man is admitted to the neurology ward with Guillain-Barré syndrome (GBS). Leg weakness began 4 days ago and is spreading upward. He had diarrhea 2 weeks before. He weighs 70 kg and has no other illness.

A lumbar puncture is done. Normal values: protein 15–45 mg/dL; white blood cells 0–5 cells/µL; glucose 50–80 mg/dL.
Protein: 190 mg/dL
White blood cells: 3 cells/µL
Glucose: 64 mg/dL
Which interpretation is correct?

## 보기

1. Bacterial meningitis pattern that needs antibiotics now
2. Albuminocytologic dissociation typical of the disorder **✔ 정답**
3. Viral meningitis pattern with only a mild cell response
4. Protein from blood leaking in during a traumatic tap

**정답: 2**

## 해설

A high cerebrospinal fluid protein with a normal white cell count, called albuminocytologic dissociation, is the typical finding in Guillain-Barré syndrome, although it may be normal in the first week. Meningitis raises the white cell count, and bacterial infection also lowers glucose; here the cell count and glucose are normal.

## 심화 해설

Reading the cerebrospinal fluid pattern
The lumbar puncture shows a cerebrospinal fluid (CSF) protein of 190 mg/dL, more than four times the upper limit of 45 mg/dL, while the white cell count is 3 cells/µL and glucose is 64 mg/dL, both within normal limits. A high protein with a normal cell count is called albuminocytologic dissociation. Albuminocytologic dissociation is the classic CSF finding in Guillain-Barré syndrome (GBS), the immune-mediated attack on peripheral nerves and nerve roots. The client's story fits the disorder: symmetric weakness that started in the legs and is ascending, beginning about 2 weeks after a diarrheal illness, a common trigger for GBS.

Why protein rises without cells
In GBS the immune response targets the myelin or axons of the spinal nerve roots as they pass through the subarachnoid space. Inflammation of the roots makes the blood-nerve barrier leaky, so plasma proteins enter the CSF. Because the process is not an infection of the meninges, white cells are not drawn into the fluid, and glucose, which is consumed by bacteria and white cells in meningitis, stays normal. Timing matters: the protein rise may be absent during the first week of symptoms and becomes more evident later, so a normal early CSF does not rule out GBS. This client is on day 4, yet the protein is already clearly elevated, which supports the diagnosis.

How the other patterns differ
Each distractor names a real CSF pattern, but none fits these numbers. The key discriminators are the white cell count and glucose.

| Pattern | White cells | Glucose | Protein |
| --- | --- | --- | --- |
| Guillain-Barré syndrome | Normal | Normal | High |
| Bacterial meningitis | Markedly high | Low | High |
| Viral meningitis | Mildly to moderately high | Usually normal | Normal or mildly high |
| Traumatic tap | Raised along with red cells | Normal | Raised by blood |

Watch out! Bacterial meningitis also raises protein, but it always comes with a marked rise in white cells and a fall in glucose. Viral meningitis, even when mild, still shows more white cells than normal. A traumatic tap carries blood into the sample, so red and white cells rise together with protein; a normal cell count argues strongly against it.

Nursing implications
Recognizing albuminocytologic dissociation helps confirm GBS so that treatment with intravenous immunoglobulin or plasma exchange can begin. The CSF result does not change the immediate nursing priority, which is the risk of ascending weakness reaching the respiratory muscles. The nurse continues serial respiratory assessment, watches for autonomic instability, and observes the puncture site and for post-procedure headache. Key point! High CSF protein with a normal white cell count and normal glucose means albuminocytologic dissociation, the hallmark of Guillain-Barré syndrome.

## 임상 시나리오

CSF in Guillain-Barré SyndromeAlbuminocytologic dissociation
The client has ascending symmetric weakness 2 weeks after diarrhea. His CSF protein is 190 mg/dL with 3 cells/µL and normal glucose: high protein without cells, the classic albuminocytologic dissociation of GBS.

Inflamed spinal nerve roots leak plasma protein into the CSF, but the meninges are not infected, so white cells and glucose stay normal. Meningitis raises white cells, and bacterial meningitis also lowers glucose.

The diagnosis supports early immunoglobulin or plasma exchange, while the nurse keeps monitoring respiratory function and autonomic signs.

CautionCSF protein may still be normal in the first week of GBS; a normal early result does not exclude the disorder.

## 핵심 개념

- **Albuminocytologic dissociation** — A high cerebrospinal fluid protein with a normal white cell count, the typical spinal fluid finding in Guillain-Barré syndrome.
- **Guillain-Barré syndrome** — An acute immune-mediated polyneuropathy causing ascending symmetric weakness, often after a respiratory or diarrheal infection.
- **Lumbar puncture** — Insertion of a needle into the lumbar subarachnoid space to sample cerebrospinal fluid or measure its pressure.
- **Traumatic tap** — A lumbar puncture in which the needle injures a small vessel, adding blood and raising red cells and protein in the sample.

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