Guillain-Barre syndrome (GBS) is an acute inflammatory polyneuropathy that is classified according to symptoms and divided into axonal and demyelinating forms.
Two-thirds of patients have a history of gastroenteritis or influenza-like illness weeks before onset of neurological symptoms.
GBS is associated with outbreaks of Zika virus. As with other viral infections, there are occasional reports of GBS associated with coronavirus disease 2019 (COVID-19) infection, although this is very rare.
Approximately 20% to 30% of patients with GBS will develop respiratory muscle weakness requiring ventilation.
Neurophysiology is confirmatory and is abnormal in most patients, even early in the disease.
Lumbar puncture is useful, and the classic finding is elevated protein with normal cell count (albuminocytological dissociation).
Treatment combines supportive and disease-modifying therapy (high-dose immunoglobulin or plasma exchange).
Guillain-Barre syndrome (GBS) is an acute inflammatory neuropathy. It is a clinically defined syndrome characterised by motor difficulty, absence of deep tendon reflexes, paraesthesias without objective sensory loss, and increased cerebrospinal fluid albumin with a normal cell count (albuminocytological dissociation). Acute inflammatory demyelinating polyradiculoneuropathy is the most commonly encountered variant.
History and exam
Key diagnostic factors
- presence of risk factors
- muscle weakness
- back/leg pain
- respiratory distress
- speech problems
- facial weakness
- bulbar dysfunction causing oropharyngeal weakness
- extra-ocular muscle weakness
- facial droop
- pupillary dysfunction
Other diagnostic factors
- altered level of consciousness
- preceding viral illness
- preceding bacterial infection
- preceding mosquito-borne viral infection
- hepatitis E infection
- cancer and lymphoma
- older age
- HIV infection
- COVID-19 infection
1st investigations to order
- nerve conduction studies
- lumbar puncture
Investigations to consider
- anti-ganglioside antibody
- stool culture
- HIV antibodies
- spinal MRI
- Borrelia burgdorferi serology
- cerebrospinal fluid (CSF) meningococcal polymerase chain reaction
- CSF cytology
- CSF angiotensin-converting enzyme
- chest x-ray
- CSF VDRL
- CSF West Nile polymerase chain reaction
- ultrasound imaging of peripheral nerves
ambulatory within 2 weeks of onset or non-ambulatory within 4 weeks of onset
Saiju Jacob, MD, DPhil, MRCP (UK), FRCP (Lon)
Queen Elizabeth Neurosciences Centre
University Hospital Birmingham
SJ has served as an international advisory board member for Alexion, Alnylam, ArgenX, Regeneron, Immunovant, and UCB pharmaceuticals. He is currently an expert panel member of the Myasthenia Gravis consortium for ArgenX, and has received speaker fees from Terumo BCT and Eisai.
Dr Saiju Jacob would like to gratefully acknowledge Dr John B. Winer, Dr Michael T. Torbey, Dr Dhruvil J. Pandya, and Dr Prem A. Kandiah, previous contributors to this topic.
JBW, MTT, DJP, and PAK declare that they have no competing interests.
Cigdem Akman, MD
Division of Pediatric Neurology
Columbia University College of Physicians and Surgeons
CA declares that he has no competing interests.
Robert Hadden, FRCP, PhD
King's College Hospital
RH has been paid by Baxter Healthcare Ltd for membership of its neurology advisory board, and is a co-author of several studies referenced in this topic.
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