Guillain-Barre syndrome

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Última revisão: 8 Dec 2025

Última atualização: 10 Nov 2022

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).

Definição

Guillain-Barre syndrome (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]

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

ptosis
altered level of consciousness
ataxia

Detalhes completos

Fatores de risco

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

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
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

Novos exames

ultrasound imaging of peripheral nerves

Algoritmo de tratamento

AGUDA

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

Colaboradores

Autores

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

Consultant Neurologist

Queen Elizabeth Neurosciences Centre

University Hospital Birmingham

Birmingham

Declarações

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.

Agradecimentos

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.

Declarações

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

Revisores

Cigdem Akman, MD

Division of Pediatric Neurology

Columbia University College of Physicians and Surgeons

New York

Declarações

CA 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.

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Referências

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Principais artigos

Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet. 2016 Aug 13;388(10045):717-27.Texto completo Resumo

Stowe J, Andrews N, Wise L, et al. Investigation of the temporal association of Guillain-Barré syndrome with influenza vaccine and influenzalike illness using the United Kingdom General Practice Research Database. Am J Epidemiol. 2009 Feb 1;169(3):382-8.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

Lawn ND, Fletcher DD, Henderson RD, et al. Anticipating mechanical ventilation in Guillain-Barré syndrome. Arch Neurol. 2001 Jun;58(6):893-8.Texto completo Resumo

Hughes RA, Brassington R, Gunn AA, et al. Corticosteroids for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2016 Oct 24;(10):CD001446.Texto completo Resumo

Walgaard C, Jacobs BC, Lingsma HF, et al. Second intravenous immunoglobulin dose in patients with Guillain-Barré syndrome with poor prognosis (SID-GBS): a double-blind, randomised, placebo-controlled trial. Lancet Neurol. 2021 Apr;20(4):275-83. 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
- Transverse myelitis
- Myasthenia gravis
- Lambert-Eaton myasthenic syndrome (LEMS)
Mais Diagnósticos diferenciais
Diretrizes
- 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
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
Mais vídeos
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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

Novos exames

Algoritmo de tratamento

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

Colaboradores

Autores

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

Declarações

Agradecimentos

Declarações

Revisores

Cigdem Akman, 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