Síndrome de Guillain-Barré
Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- debilidad muscular
- parestesia
- dolor de espalda/pierna
- dificultad respiratoria
- dificultad del habla
- arreflexia/hiporreflexia
- debilidad facial
- disfunción bulbar que causa debilidad orofaríngea
- debilidad muscular extraocular
- parálisis facial
- diplopía
- disartría
- disfagia
- disautonomía
- disfunción pupilar
- oftalmoplejía
Other diagnostic factors
- ataxia
- ptosis
- nivel de alteración de la consciencia
Risk factors
- enfermedad viral previa
- infección bacteriana anterior
- infección vírica anterior transmitida por artrópodos
- infección por hepatitis E
- inmunización
- cáncer y linfoma
- inmunoterapia con inhibidor de puntos de control inmunitarios o receptor de antígenos quiméricos (CAR) para células T
- edad avanzada
- Infección por VIH
- Infección por COVID-19
- sexo masculino
Diagnostic tests
1st tests to order
- estudios de conducción nerviosa
- punción lumbar
- pruebas de función hepática (PFH)
- espirometría
Tests to consider
- anticuerpo antigangliósido
- serología
- coprocultivo
- anticuerpos del VIH
- resonancia magnética (IRM) espinal
- estudios por imágenes de ecografía de los nervios periféricos
- serología de Borrelia burgdorferi
- Reacción en cadena de la polimerasa meningocócica del líquido cefalorraquídeo (LCR)
- citología de líquido cefalorraquídeo (LCR)
- La enzima convertidora de angiotensina del LCR
- radiografía de tórax
- prueba de laboratorio de investigación de enfermedades venéreas (VDRL) en el líquido cefalorraquídeo (LCR)
- Reacción en cadena de la polimerasa del Nilo Occidental en LCR
Treatment algorithm
debilidad bulbar no ambulatoria o severa o inestabilidad autonómica dentro de las 4 semanas posteriores al inicio; o ambulatorio con enfermedad leve dentro de las 2 semanas siguientes al inicio
Contributors
Authors
Saiju Jacob, MD, DPhil, MRCP (UK), FRCP (Lon), FAAN
Consultant Neurologist
Queen Elizabeth Neurosciences Centre
University Hospital Birmingham
Birmingham
UK
Disclosures
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
UK
Disclosures
RI declares that he has no competing interests.
Acknowledgements
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.
Disclosures
JBW, MTT, DJP, and PAK declare that they have no competing interests.
Peer reviewers
Long Davalos Loo, MD
Assistant Professor of Neurology
University of Cincinnati
Cincinnati
OH
Disclosures
LDL declares that he has no competing interests.
Robert Hadden, FRCP, PhD
Consultant Neurologist
King's College Hospital
London
UK
Disclosures
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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.Full text Abstract
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.Full text Abstract
Hughes RA, Swan AV, van Doorn PA. Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2014 Sep 19;(9):CD002063.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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