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Guillain-Barre syndrome

Last reviewed: 4 Nov 2023
Last updated: 10 Nov 2022



History and exam

Key diagnostic factors

  • muscle weakness
  • paresthesia
  • back/leg pain
  • respiratory distress
  • speech problems
  • areflexia/hyporeflexia
  • facial weakness
  • bulbar dysfunction causing oropharyngeal weakness
  • extraocular muscle weakness
  • facial droop
  • diplopia
  • dysarthria
  • dysphagia
  • dysautonomia
  • pupillary dysfunction
  • ophthalmoplegia
More key diagnostic factors

Other diagnostic factors

  • ptosis
  • altered level of consciousness
  • ataxia
Other diagnostic factors

Risk factors

  • preceding viral illness
  • preceding bacterial infection
  • preceding mosquito-borne viral infections
  • hepatitis E infection
  • immunization
  • cancer and lymphoma
  • older age
  • HIV infection
  • COVID-19 infection
  • male
More risk factors

Diagnostic investigations

1st investigations to order

  • nerve conduction studies
  • lumbar puncture
  • LFTs
  • spirometry
More 1st investigations to order

Investigations to consider

  • antiganglioside antibody
  • serology
  • 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 West Nile polymerase chain reaction
More investigations to consider

Emerging tests

  • ultrasound imaging of peripheral nerves

Treatment algorithm


ambulatory within 2 weeks of onset or nonambulatory within 4 weeks of onset



Saiju Jacob, MD, DPhil, MRCP (UK), FRCP (Lon)

Consultant Neurologist

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.

Peer reviewers

Cigdem Akman, MD

Division of Pediatric Neurology

Columbia University College of Physicians and Surgeons

New York



CA declares that he has no competing interests.

Robert Hadden, FRCP, PhD

Consultant Neurologist

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.

  • Differentials

    • Transverse myelitis
    • Myasthenia gravis
    • Lambert-Eaton myasthenic syndrome (LEMS)
    More Differentials
  • Guidelines

    • 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
    More Guidelines
  • Patient leaflets

    Lumbar puncture

    Guillain-Barre syndrome

    More Patient leaflets
  • Videos

    Diagnostic lumbar puncture in adults: animated demonstration

    Tracheal intubation: animated demonstration

    More videos
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