Guillain-BarrÉ Syndrome
- Acute inflammatory demyelinating polyneuropathy (delayed conduction in nerve fibres)
- Progressive symmetric ascending muscle weakness
- Hyporeflexia
- +/- sensory
- +/- autonomic involvement
- Autoimmune response following recent infection, symptoms resolving with remyelination
- <10% death rate (usually ARDS, PE, Sepsis, pneumonia)
- Young adults and elderly
Cranial nerve variant = Miller Fisher
History
- Recent 'flu' like illness then
- Paraesthesia in digits
- Progressive, ascending, proximal muscle weaknes (rising from sitting, combing hair)
- Shoulder and hip girdle pain
- Beware respiratory muscle or bulbar involvement
Examination
- Absent reflexes knee and ankle reflexes
- Loss vibration / proprioception first
- Autonomic disturbance (BP, pulse, urinary retention, salivation)
- Tonic pupils
Clinical Diagnosis
- CSF - Raised protein, few WBC
- Studies to outrule viral and toxidromes
- NB - check the FVC (forced vital capacity) - <20ml/kg may need intubation
- ECG - AV bklock, T and ST abnormalities, Wide QRS
Treatment
- O2 +/- assisted ventilation (aprtcularly low FVC, aspiration)
- IV access
- Monitor
- Atropine (+/- pacing) for bradycardia
- Short-acting Β-blocker if severe hypertension
- DVT prophylaxis
- Plasma exchange (PE), immuno-globulin (IVIG) are effective
- Steroids ineffective
Differential Dx
- Cauda Equina
- Botulism
- Diphtheria
- Encephalitis
- Hyperkalemia
- Hypokalemia
- Hypophosphatemia
- Meningitis
- Multiple Sclerosis
- Myasthenia Gravis
- Polymyositis
- Spinal Cord Infections / injuries
- Tick-Borne Diseases, Lyme
- Toxicity - Alcohols or Heavy Metals
- Toxicity - Organophosphate and Carbamate
- Thiamine deficinece
