Guillain-Barré Syndrome

Overview

Guillain-Barré syndrome is an acute immune-mediated peripheral neuropathy that commonly presents with progressive weakness and reduced or absent reflexes.

The syndrome may develop following an infectious illness, although the trigger and clinical course vary between patients.

Respiratory and autonomic complications are major concerns in Guillain-Barré syndrome.

Clinical Features

Weakness typically progresses over time and may involve the lower limbs first before extending to the upper limbs and respiratory muscles.

Sensory symptoms and autonomic dysfunction may also occur.

Reduced or absent deep tendon reflexes are an important clinical clue.

Investigation

Assessment may include nerve conduction studies, electromyography, and cerebrospinal fluid analysis.

Serial respiratory assessment is essential because respiratory muscle weakness can progress rapidly.

The need for respiratory monitoring should be determined clinically and reassessed repeatedly as the illness evolves.

Management

Management focuses on close monitoring, prevention and treatment of complications, and appropriate immunotherapy.

Intravenous immunoglobulin or plasma exchange may be used in appropriate patients.

Respiratory failure, autonomic instability, pain, and thromboembolic risk require active supportive management.

Clinical Pearls