Guillain-Barre Syndrome (GBS)

Background 

  • Rapid-onset polyneuropathy that manifests most often with ascending weakness and numbness that can involve the respiratory and facial musculature
  • Usually preceded by infectious illness a few weeks prior (Campylobacter, CMV, Flu, HIV, etc)
  • Pts are much more likely to get GBS from an infection than any vaccine, weak vaccine links to GBS are an additional 1-2 cases per million flu vaccines

Presentation 

  • Most common form is acute inflammatory demyelinating polyneuropathy (AIDP)
  • Progressive extremity weakness, weak or absent reflexes, and potentially subjective sensatory changes, especially back pain, with nadir being reached within 4 weeks
  • Sensory loss is common in an ascending pattern too
  • There are many variants of GBS
  • Miller-Fischer Syndrome: ophthalmoplegia, ataxia
  • Bickerstaff brainstem encephalitis: encephalopathy, ophthalmoplegia, ataxia
  • Pure Sensory GBS: sensory loss with only mild motor involvement
  • Do not use lack of classic ascending weakness to dismiss the idea of GBS

Evaluation

  • LP: albuminocytologic dissociation = high protein with normal cell count
    • One exception is HIV, which can cause AIDP but also have a high cell count and high protein count
  • EMG/NCV: usually normal early in course, so typically performed at least 2 weeks after symptom onset
  • MRI L-Spine w/wo: Assess for spinal cord lesions, can demonstrate nerve root enhancement
  • Ddx: Spinal cord lesions, LEMS, MG, acute HIV or HCV, viral myelitis (enterovirus/WNV)

Management 

  • ABCs! Ensure adequate respiratory status with baseline NIF/VC, then Q4-6H
  • NIF > -30 with good effort, generally warrants ICU monitoring
  • IVIG or PLEX
  • Avoid steroids as they can worsen symptoms
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