Síndrome de Guillain-Barré
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- fraqueza muscular
- parestesia
- dorsalgia/dor nas pernas
- dificuldade respiratória
- problemas de fala
- arreflexia/hiporreflexia
- fraqueza facial
- disfunção bulbar que causa fraqueza orofaríngea
- fraqueza muscular extraocular
- paralisia facial
- diplopia
- disartria
- disfagia
- disautonomia
- disfunção pupilar
- oftalmoplegia
Outros fatores diagnósticos
- ataxia
- ptose
- nível alterado de consciência
Fatores de risco
- doença viral precedente
- infecção bacteriana precedente
- infecção viral transmitida por artrópodes que precede a infecção
- infecção por hepatite E
- imunização
- câncer e linfoma
- imunoterapia com inibidor de checkpoint imunológico ou células T com receptor de antígeno quimérico (CAR)
- idade avançada
- Infecção pelo vírus da imunodeficiência humana (HIV)
- Infecção por COVID-19
- sexo masculino
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- estudos da condução nervosa
- punção lombar
- TFHs
- espirometria
Investigações a serem consideradas
- anticorpo anti-gangliosídeo
- sorologia
- coprocultura
- anticorpos antivírus da imunodeficiência humana (anti-HIV)
- ressonância nuclear magnética (RNM) espinhal
- ultrassonografia dos nervos periféricos
- sorologia para Borrelia burgdorferi
- reação em cadeia da polimerase para meningococos para o líquido cefalorraquidiano (LCR)
- citologia do líquido cefalorraquidiano (LCR)
- enzima conversora de angiotensina no LCR
- radiografia torácica
- VDRL no líquido cefalorraquidiano (LCR)
- reação em cadeia da polimerase do Nilo Ocidental para o LCR
Algoritmo de tratamento
incapaz de deambular ou fraqueza bulbar grave ou instabilidade autonômica até 4 semanas após o início; ou deambulando com doença leve até 2 semanas após início
Colaboradores
Autores
Saiju Jacob, MD, DPhil, MRCP (UK), FRCP (Lon), FAAN
Consultant Neurologist
Queen Elizabeth Neurosciences Centre
University Hospital Birmingham
Birmingham
UK
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
UK
Declarações
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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