How does Guillain-Barré syndrome typically progress?

• A. Begins in lower extremities and ascends bilaterally with weakness, ataxia, paresthesia, progressing to paralysis
• B. Begins in the facial muscles and ascends to the limbs
• C. Starts with cognitive decline and memory loss
• D. Localizes to one limb

Answer: (A)

Guillain-Barré syndrome progresses as an acute, ascending, symmetric weakness. It typically begins with weakness and abnormal sensations in the lower legs, then moves upward to involve the thighs, trunk, arms, and potentially the bulbar and respiratory muscles as it worsens. Sensory changes like paresthesias and sometimes ataxia accompany the weakness, and reflexes are reduced or absent. This upward, bilateral progression with sensory involvement is the hallmark pattern, helping distinguish it from conditions that start with facial weakness, cognitive decline, or weakness localized to a single limb. Therefore, starting in the lower extremities and ascending bilaterally with weakness, paresthesias, and progression to paralysis best fits Guillain-Barré syndrome.