In Guillain-Barré, what is the typical direction of weakness on the body?

• A. Descending from head to toe
• B. Ascending from legs upward
• C. Proximal to distal symmetric
• D. Random distribution

Answer: (B)

The weakness in Guillain-Barré typically begins in the legs and ascends upward toward the trunk and arms. This ascending pattern reflects the immune-mediated attack on peripheral nerves, which often affects the longest fibers first, so the legs are the first to be involved and then progress proximally. You’ll often see rapid progression over hours to days with areflexia, and sometimes facial weakness or autonomic changes as the process advances. This makes an ascending, symmetrical pattern the characteristic description, unlike a descending pattern from the head, a fixed proximal-to-distal sequence in other kinds of weakness, or a random distribution.