Guillain-Barre syndrome

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Última revisão das evidências: 6 Apr 2026

Última atualização do tópico: 13 Jan 2026

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. The acute infectious illness is usually viral, but sometimes bacterial.

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).

Definição

GBS is an acute inflammatory neuropathy.[1][2] 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).[1][3] Acute inflammatory demyelinating polyradiculoneuropathy is the most commonly encountered variant.[4] The acute infectious illness is usually viral (e.g., cytomegalovirus, Epstein-Barr virus, hepatitis E), but sometimes bacterial (e.g., Campylobacter jejuni, Mycoplasma species). Several arthropod-borne viral infections have been linked to GBS including Zika, dengue, chikungunya, Japanese encephalitis and Oropouche fever.[5][6][7][8][9][10] This topic focuses on diagnosis and management of GBS in adults.

História e exame físico

Principais fatores diagnósticos

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

Detalhes completos

Outros fatores diagnósticos

ataxia
ptosis
altered level of consciousness

Detalhes completos

Fatores de risco

preceding viral illness
preceding bacterial infection
preceding arthropod-borne viral infections
hepatitis E infection
immunization
cancer and lymphoma
immune checkpoint inhibitor or chimeric antigen receptor (CAR) T-cell immunotherapy
older age
HIV infection
COVID-19 infection
male sex

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

nerve conduction studies
lumbar puncture
LFTs
spirometry

Detalhes completos

Investigações a serem consideradas

antiganglioside antibody
serology
stool culture
HIV antibodies
spinal MRI
ultrasound imaging of peripheral nerves
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

Detalhes completos

Algoritmo de tratamento

AGUDA

nonambulatory or severe bulbar weakness or autonomic instability within 4 weeks of onset; or ambulatory with mild disease within 2 weeks of onset

Colaboradores

Autores

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

Consultant Neurologist

Queen Elizabeth Neurosciences Centre

University Hospital Birmingham

Birmingham

Declarações

SJ has served as a paid international advisory board member or invited speaker for Alexion, Alnylam, ArgenX, Immunovant, Janssen, Merck, Novartis, Regeneron and UCB pharmaceuticals, is currently an expert panel member of the Myasthenia Gravis Consortium for Argenx pharmaceuticals. He has received speaker’s fees from Terumo BCT and Eisai pharmaceuticals. SJ declares that none of these are relevant to the current article.

Roshan Iqbal, MD, DM, MRCP (UK)

Neurology Specialist Registrar

Queen Elizabeth Neurosciences Centre

University Hospital Birmingham

Birmingham

Declarações

RI declares that he has no competing interests.

Agradecimentos

Prof Saiju Jacob would like to gratefully acknowledge Prof John B. Winer, Dr Michael T. Torbey, Dr Dhruvil J. Pandya, and Dr Prem A. Kandiah, previous contributors to this topic.

Declarações

JBW, MTT, DJP, and PAK declare that they have no competing interests.

Revisores

Long Davalos Loo, MD

Assistant Professor of Neurology

University of Cincinnati

Cincinnati

Declarações

LDL declares that he has no competing interests.

Robert Hadden, FRCP, PhD

Consultant Neurologist

King's College Hospital

London

Declarações

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.

Créditos aos pareceristas

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As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

van Doorn PA, Van den Bergh PYK, Hadden RDM, et al. European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of Guillain-Barré syndrome. Eur J Neurol. 2023 Dec;30(12):3646-74.Texto completo Resumo

Leonhard SE, Mandarakas MR, Gondim FAA, et al. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol. 2019 Nov;15(11):671-83.Texto completo Resumo

Hughes RA, Swan AV, van Doorn PA. Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2014 Sep 19;(9):CD002063.Texto completo Resumo

Hughes RA, Wijdicks EF, Barohn R, et al. Practice parameter: immunotherapy for Guillain-Barré syndrome: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2003 Sep 23;61(6):736-40.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Acute-onset chronic inflammatory demyelinating polyradiculoneuropathy (A-CIDP)
- Transverse myelitis
- Myasthenia gravis
Mais Diagnósticos diferenciais
Diretrizes
- Guideline on diagnosis and treatment of Guillain-Barré syndrome
- Diagnosis and treatment of Guillain-Barre syndrome in childhood and adolescence: an evidence- and consensus-based guideline
Mais Diretrizes
Folhetos informativos para os pacientes
Lumbar puncture
Guillain-Barre syndrome
Mais Folhetos informativos para os pacientes
Videos
Diagnostic lumbar puncture in adults: animated demonstration
Tracheal intubation: animated demonstration
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Guillain-Barre syndrome

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

nonambulatory or severe bulbar weakness or autonomic instability within 4 weeks of onset; or ambulatory with mild disease within 2 weeks of onset

Colaboradores

Autores

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

Declarações

Roshan Iqbal, MD, DM, MRCP (UK)

Declarações

Agradecimentos

Declarações

Revisores

Long Davalos Loo, MD

Declarações

Robert Hadden, FRCP, PhD

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Videos

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice