Guillain-Barré Syndrome
Background
- Acute inflammatory demyelinating polyneuropathy (delayed conduction in nerve fibres)
- Progressive symmetric ascending muscle weakness
- Cranial nerve variant = Miller Fisher
- 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
History
- Recent 'flu' like illness then
- Paraesthesia in digits
- Progressive, ascending, proximal muscle weakness
- Shoulder and hip girdle pain
- Beware respiratory muscle or bulbar involvement
- Max weakness usually @2 weeks
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 out-rule viral and toxidromes
- Check the FVC (forced vital capacity) - <20ml/kg may need intubation
- ECG - AV block, T & ST abnormalities, wide QRS
Treatment
- O2 ± assisted ventilation (particularly low FVC, aspiration)
- IV access
- Monitor
- Atropine (± pacing) for bradycardia
- Short-acting β-blocker if severe hypertension
- DVT prophylaxis
- Plasma exchange (PE), immunoglobulin (IVIG) are effective
- Steroids ineffective
Content by Dr Íomhar O' Sullivan 28/11/2008. Last review Dr ÍOS 27/12/22.