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Guillain Barre Syndrome (GBS)

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, areflexia

  • 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! Then 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