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 neurologic 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 (albuminocytologic dissociation).
Treatment combines supportive and disease-modifying therapy (high-dose immune globulin or plasma exchange).
Guillain-Barre syndrome (GBS) is an acute inflammatory neuropathy. It is a clinically defined syndrome characterized by motor difficulty, absence of deep tendon reflexes, paresthesias without objective sensory loss, and increased cerebrospinal fluid albumin with a normal cell count (albuminocytologic dissociation). Acute inflammatory demyelinating polyradiculoneuropathy is the most commonly encountered variant.
History and exam
Key diagnostic factors
- muscle weakness
- back/leg pain
- respiratory distress
- speech problems
- facial weakness
- bulbar dysfunction causing oropharyngeal weakness
- extraocular muscle weakness
- facial droop
- pupillary dysfunction
Other diagnostic factors
- altered level of consciousness
- preceding viral illness
- preceding bacterial infection
- preceding mosquito-borne viral infections
- 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
- antiganglioside 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 nonambulatory within 4 weeks of onset
- Transverse myelitis
- Myasthenia gravis
- Lambert-Eaton myasthenic syndrome (LEMS)
- Diagnosis and treatment of Guillain-Barre syndrome in childhood and adolescence: an evidence- and consensus-based guideline
- Diagnosis and management of Guillain-Barré syndrome in ten steps
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