Which pattern is most characteristic of Guillain-Barré syndrome?

• A. Ascending symmetric weakness with decreased deep tendon reflexes
• B. Descending weakness with spasticity
• C. Focal unilateral weakness
• D. Chronic progressive weakness over months

Answer: (A)

Guillain-Barré syndrome is an acute inflammatory process affecting the peripheral nerves, so the most distinctive pattern is rapidly progressing, symmetric weakness that begins in the legs and ascends toward the arms and face, with diminished or absent deep tendon reflexes. This upward, bilateral progression paired with hyporeflexia is the clue that points to a peripheral nerve process rather than a central one. Sensory symptoms like tingling can occur, but motor weakness tends to dominate. This contrasts with patterns like descending weakness with spasticity (which suggests central causes or conditions like botulism in different contexts), focal unilateral weakness (stroke or focal nerve injury), or chronic progressive weakness over months (CIDP or other chronic neuropathies). The ascending, symmetric, hyporeflexic presentation is the hallmark that makes Guillain-Barré syndrome the best fit.