Guillain-Barre Syndrome - Summary



Acute AIDP that presents with rapidly progressive flaccid weakness



Epidemiology:

 • 1-2 cases/100,000 per year

 • Slightly greater in males than females



Guillain-Barre Pathophysiology:

 • Immune response preceding infection

	- Campylobacter jejuni

	- HIV, CMV, EBV

	- Influenza like illnesses, COVID 19

	- Zika virus

	- Vaccination (flu, meningococcal, H1N1)



Clinical Manifestations:

 • Fairly symmetric muscle weakness

 • Absent or depressed DTR’s

 • Onset: Few days to a week

 • Weakness: mild difficulty with walking to nearly complete paralysis of all extremity, facial, respiratory and bulbar muscles



Guillain-Barre Clinical Features:

 • Weakness: Starts in legs and ascends usually. Can begin in arms or face (10% of patients)

 • Respiratory Muscle Weakness: May require ventilator support (10-30%)

 • Facial Nerve Palsies / Oropharyngeal Weakness

 • Oculomotor Weakness

 • Decreased / Absent Reflexes: Arms or legs

 • Paresthesias: Hands or feet

 • Pain: Due to nerve root inflammation. Back or extremities

 • Dysautonomia: Life threatening labile BP and arrythmias

 • Other: Diarrhea/constipation, hyponatremia, bradycardia, urinary retention, tachycardia, reversible cardiomyopathy, Horner syndrome, Sudden death



Miller Fisher Syndrome:

 • Opthaloplegia

 • Ataxia

 • Areflexia



Guillain-Barre Diagnosis:

 • CSF:

	- CSF PROTEIN

	- NORMAL CSF WBC (Albuminocytologic dissociation)

 • Electrodiagnostic studies - EMG, NCV can classify the main variants:

	(1) acute polyneuropathy with demyelination features

	(2) axonal form

 • MRI - Thickening and enhancement of intrathecal spinal nerve roots and cauda equina

 • GQ1b IgG Antibody associated with Miller Fisher Variant.



Treatment:

 • Plasmapheresis + IVIG

 • Mechanical ventilation

 • Steroids contraindicated- worse outcome



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