Guillain-Barre syndrome 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.
Associated with Zika virus outbreaks.
Up to 30% will develop respiratory muscle weakness requiring ventilation.
Neurophysiology is confirmatory and is abnormal in 85% of 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 (plasma exchange or high-dose immunoglobulin).
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 absence of cellular reaction (albuminocytological dissociation). Acute inflammatory demyelinating polyradiculoneuropathy is the most commonly encountered variant.
History and exam
- presence of risk factors
- muscle weakness
- respiratory distress
- speech problems
- back/leg pain
- facial weakness
- bulbar dysfunction causing oropharyngeal weakness
- extra-ocular muscle weakness
- facial droop
- non-reactive pupil
Saiju Jacob, MD, DPhil, MRCP (UK), FRCP (Lon)
Queen Elizabeth Neurosciences Centre
University Hospital Birmingham
SJ is an Advisory Board member for Alexion Pharmaceuticals and Alnylam Pharmaceuticals. He lectures and is involved in other educational events for Terumo BCT and Eisai Ltd. He has attended clinical trial meetings as Chief/Principal Investigator for Argenx Ltd and Momenta Ltd.
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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