Guillain-Barre syndrome - Revision history

Tyrelkfisher: early presentations for pediatrics may present with thigh pain/refusal to walk. Reference: https://pdf.sciencedirectassets.com/273483/1-s2.0-S0065310123X00024/1-s2.0-S0065310123000087/main.pdf?X-Amz-Security-Token=IQoJb3JpZ2luX2VjEOL%2F%2F%2F%2F%2F%2F%2F%

2026-01-09T18:52:46Z

early presentations for pediatrics may present with thigh pain/refusal to walk. Reference: https://pdf.sciencedirectassets.com/273483/1-s2.0-S0065310123X00024/1-s2.0-S0065310123000087/main.pdf?X-Amz-Security-Token=IQoJb3JpZ2luX2VjEOL%2F%2F%2F%2F%2F%2F%2F%

← Older revision		Revision as of 18:52, 9 January 2026
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	*May progress to diaphragm resulting in need for mechanical ventilation (33% of patients)		*May progress to diaphragm resulting in need for mechanical ventilation (33% of patients)
	*Autonomic dysfunction occurs in 50% of patients		*Autonomic dysfunction occurs in 50% of patients
			*In pediatrics, may present with pain (typically in the thighs) and refusal to walk

	===Required===		===Required===

Mholtz at 04:33, 9 June 2022

2022-06-09T04:33:40Z

← Older revision		Revision as of 04:33, 9 June 2022
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	==Disposition==		==Disposition==
			*Admit

	===Indications for admission to ICU===		===Indications for admission to ICU===
	*Autonomic dysfunction		*Autonomic dysfunction

Elcatracho: /* Intubation indications */

2022-01-19T16:59:48Z

Intubation indications

← Older revision		Revision as of 16:59, 19 January 2022
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	*Bulbar dysfunction (difficulty with breathing, swallowing, or speech)		*Bulbar dysfunction (difficulty with breathing, swallowing, or speech)
	*Aspiration		*Aspiration
	*''Avoid'' [[succinylcholine]] during intubation, as this may cause severe hyperkalemia		*''Avoid'' [[succinylcholine]] during intubation, as this may cause severe [[hyperkalemia]]

	==Disposition==		==Disposition==

Ptseng at 15:54, 12 February 2021

2021-02-12T15:54:15Z

← Older revision		Revision as of 15:54, 12 February 2021
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	*Acute polyneuropathy due to immune-mediated peripheral nerve myelin sheath destruction		*Acute polyneuropathy due to immune-mediated peripheral nerve myelin sheath destruction
	*Although there is often a motor component, patients can also present with sensory deficits.		*Although there is often a motor component, patients can also present with sensory deficits.
	*Associated with [[viral syndrome\|viral]] or febrile illness, [[~~campylobacter~~]] infection, or vaccination		*Associated with [[viral syndrome\|viral]] or febrile illness, [[Campylobacter]] infection, or vaccination
	*Symptoms at worst 2-4wk after onset, then plateau for 2-4wk, then remit from wks-months		*Symptoms at worst 2-4wk after onset, then plateau for 2-4wk, then remit from wks-months
	*Associated with [[Campylobacter jejuni]], [[cytomegalovirus]], [[Epstein-Barr virus]], and [[Mycoplasma pneumoniae]]		*Associated with [[Campylobacter jejuni]], [[cytomegalovirus]], [[Epstein-Barr virus]], and [[Mycoplasma pneumoniae]]

ClaireLewis at 15:51, 14 September 2019

2019-09-14T15:51:21Z

← Older revision		Revision as of 15:51, 14 September 2019
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	==Background==		==Background==
	*Acute polyneuropathy due to immune-mediated peripheral nerve myelin sheath destruction. Although there is often a motor component, patients can also present with sensory deficits.		*Acute polyneuropathy due to immune-mediated peripheral nerve myelin sheath destruction
	*Associated with viral or febrile illness, campylobacter infection, or vaccination		*Although there is often a motor component, patients can also present with sensory deficits.
			*Associated with [[viral syndrome\|viral]] or febrile illness, [[campylobacter]] infection, or vaccination
	*Symptoms at worst 2-4wk after onset, then plateau for 2-4wk, then remit from wks-months		*Symptoms at worst 2-4wk after onset, then plateau for 2-4wk, then remit from wks-months
	*Associated with [[Campylobacter jejuni]], [[cytomegalovirus]], [[Epstein-Barr virus]], and [[Mycoplasma pneumoniae]]		*Associated with [[Campylobacter jejuni]], [[cytomegalovirus]], [[Epstein-Barr virus]], and [[Mycoplasma pneumoniae]]

	==Clinical Features==		==Clinical Features==
	*Viral illness → ASCENDING, symmetric weakness or paralysis and loss of DTRs		*[[Viral syndrome\|Viral illness]] → ASCENDING, symmetric [[weakness]] or paralysis and loss of DTRs
	*Little or no sensory involvement		*Little or no sensory involvement
	*May progress to diaphragm resulting in need for mechanical ventilation (33% of patients)		*May progress to diaphragm resulting in need for mechanical ventilation (33% of patients)
	*Autonomic dysfunction occurs in 50% of patients		*Autonomic dysfunction occurs in 50% of patients
	~~===Variants and Subtypes===~~
	~~There are multiple Guillain Barre variants with differing presentaions<ref>Ho TW et al.~~
	Guillain-Barrésyndrome in northern China. Relationship to Campylobacter jejuni infection and anti-glycolipid antibodies. Brain. 1995;118 ( Pt 3):597. </ref><ref>Sumner AJ et al. The physiological basis for symptoms in Guillain-Barrésyndrome. Ann Neurol. 1981;9 Suppl:28. </ref>
	~~#Acute inflammatory demyelinating polyneuropathy - most common type with progressive symmetric muscle weakness often with decreased deep tendon reflexes due to peripheral nerve involvment~~
	~~#Acute motor axonal neuropathy - often associated with [[campylobacter]] infections with only motor involvement~~
	~~#Acute motor and sensory axonal neuropathy - presence both motor and sensory involement~~
	~~#Miller-Fisher Syndrome - presence of ophthalmoplegia with ataxia and areflexia~~
	~~===Miller-Fisher Syndrome===~~
	*Associated with [[campylobacter]] infection
	*More likely to be preceded by diarrhea than viral prodrome
	*Consists of ophthalmoplegia and ataxia
	*Weakness is less severe but DESCENDING; disease course milder than classic GBS
	*May present similarly to [[botulism]], which is also descending paralysis

	~~==Differential Diagnosis==~~
	~~{{Weakness DDX}}~~

	~~==Evaluation==~~
	===Required===		===Required===
	*Progressive [[weakness]] of more than one limb		*Progressive [[weakness]] of more than one limb
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	**Facial flushing		**Facial flushing
	*Absence of [[fever]] at onset		*Absence of [[fever]] at onset
	*'''Albumin-cytological dissociation of [[CSF]] (high protein (>45) and low WBC count (<10)) is most common~~. However patients~~ with HIV can have a pleocytosis<ref name="Rosen">Bunney EB, Gallagher EJ: Peripheral Nerve Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 105:p 1400-1401.</ref><ref>Brannagan TH et al. HIV-associated Guillain-Barré syndrome. J Neurol Sci. 2003;208(1-2):39. </ref>'''
			===Variants and Subtypes===
			*Multiple variants<ref>Ho TW et al.
			Guillain-Barrésyndrome in northern China. Relationship to Campylobacter jejuni infection and anti-glycolipid antibodies. Brain. 1995;118 ( Pt 3):597. </ref><ref>Sumner AJ et al. The physiological basis for symptoms in Guillain-Barrésyndrome. Ann Neurol. 1981;9 Suppl:28. </ref>
			*Acute inflammatory demyelinating polyneuropathy
			**most common type
			**progressive symmetric muscle [[weakness]]
			**often with decreased deep tendon reflexes due to peripheral nerve involvement
			*Acute motor axonal neuropathy
			**often associated with [[campylobacter]] infections
			**only motor involvement
			*Acute motor and sensory axonal neuropathy
			**presence both motor and sensory involement
			*Miller-Fisher Syndrome
			**Associated with [[campylobacter]] infection
			**More likely to be preceded by [[diarrhea]] than viral prodrome
			**Presence of ''ophthalmoplegia'' with [[ataxia]] and areflexia
			**Weakness is less severe but DESCENDING; disease course milder than classic GBS
			**May present similarly to [[botulism]], which is also descending paralysis

			==Differential Diagnosis==
			{{Weakness DDX}}

			==Evaluation==
			*[[LP]]
			**'''Albumin-cytological dissociation of [[CSF]] (high protein (>45) and low WBC count (<10)) is most common
			**Patients with HIV can have a pleocytosis<ref name="Rosen">Bunney EB, Gallagher EJ: Peripheral Nerve Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 105:p 1400-1401.</ref><ref>Brannagan TH et al. HIV-associated Guillain-Barré syndrome. J Neurol Sci. 2003;208(1-2):39. </ref>'''
	*Typical findings on electromyogram and nerve conduction studies		*Typical findings on electromyogram and nerve conduction studies
	*MRI: Selective enhancement of the anterior spinal nerve roots is suggestive<ref name="Rosen" />		*MRI: Selective enhancement of the anterior spinal nerve roots is suggestive<ref name="Rosen" />
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	==Management==		==Management==
	===[[IVIG]]===		===[[IVIG]]===
	*Treat ~~nonambulatory~~ patients within 2 weeks of symptom onset		*Treat non-ambulatory patients within 2 weeks of symptom onset

	===[[IVIG]] vs [[Plasmapheresis]]===		===[[IVIG]] vs [[Plasmapheresis]]===
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	*Bulbar dysfunction (difficulty with breathing, swallowing, or speech)		*Bulbar dysfunction (difficulty with breathing, swallowing, or speech)
	*Aspiration		*Aspiration
			*''Avoid'' [[succinylcholine]] during intubation, as this may cause severe hyperkalemia
	* Avoid succinylcholine during intubation, as this may cause severe hyperkalemia

	==Disposition==		==Disposition==

Modanq: /* Intubation indications */

2018-05-06T14:39:28Z

Intubation indications

← Older revision		Revision as of 14:39, 6 May 2018
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	*Bulbar dysfunction (difficulty with breathing, swallowing, or speech)		*Bulbar dysfunction (difficulty with breathing, swallowing, or speech)
	*Aspiration		*Aspiration

			* Avoid succinylcholine during intubation, as this may cause severe hyperkalemia

	==Disposition==		==Disposition==

ClaireLewis: /* Management */

2017-04-03T17:50:11Z

Management

← Older revision		Revision as of 17:50, 3 April 2017
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	*Treat nonambulatory patients within 2 weeks of symptom onset		*Treat nonambulatory patients within 2 weeks of symptom onset

	===IVIG vs ~~plasmapharesis~~===		===[[IVIG]] vs [[Plasmapheresis]]===
	*IVIG associated with [[thromboembolism]] and aseptic [[meningitis]]		*IVIG associated with [[thromboembolism]] and aseptic [[meningitis]]
	*Plasmapheresis associated with greater hemodynamic instability, lower rate of relapse		*Plasmapheresis associated with greater hemodynamic instability, lower rate of relapse
	*Combined IVIG and ~~plasmapharesis~~ no better than single therapy (IVIG or ~~plasmapharesis~~)		*Combined IVIG and plasmapheresis no better than single therapy (IVIG or plasmapheresis)
	*IVIG preferred due to convenience and availability		*IVIG preferred due to convenience and availability

Ostermayer: /* Management */

2016-12-04T10:08:10Z

Management

← Older revision		Revision as of 10:08, 4 December 2016
Line 52:		Line 52:
	*Treat nonambulatory patients within 2 weeks of symptom onset		*Treat nonambulatory patients within 2 weeks of symptom onset

	IVIG vs plasmapharesis		===IVIG vs plasmapharesis===
	*IVIG associated with [[thromboembolism]] and aseptic [[meningitis]]		*IVIG associated with [[thromboembolism]] and aseptic [[meningitis]]
	*Plasmapheresis associated with greater hemodynamic instability, lower rate of relapse		*Plasmapheresis associated with greater hemodynamic instability, lower rate of relapse

Ostermayer: /* Suggestive */

2016-12-04T09:28:47Z

Suggestive

← Older revision		Revision as of 09:28, 4 December 2016
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	**Facial flushing		**Facial flushing
	*Absence of [[fever]] at onset		*Absence of [[fever]] at onset
	*''Albumin-cytological dissociation of [[CSF]] (high protein (>45) and low WBC count (<10)) is most common. However patients with HIV can have a pleocytosis<ref name="Rosen">Bunney EB, Gallagher EJ: Peripheral Nerve Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 105:p 1400-1401.</ref><ref>Brannagan TH et al. HIV-associated Guillain-Barré syndrome. J Neurol Sci. 2003;208(1-2):39. </ref>''		*'''Albumin-cytological dissociation of [[CSF]] (high protein (>45) and low WBC count (<10)) is most common. However patients with HIV can have a pleocytosis<ref name="Rosen">Bunney EB, Gallagher EJ: Peripheral Nerve Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 105:p 1400-1401.</ref><ref>Brannagan TH et al. HIV-associated Guillain-Barré syndrome. J Neurol Sci. 2003;208(1-2):39. </ref>'''
	*Typical findings on electromyogram and nerve conduction studies		*Typical findings on electromyogram and nerve conduction studies
	*MRI: Selective enhancement of the anterior spinal nerve roots is suggestive<ref name="Rosen" />		*MRI: Selective enhancement of the anterior spinal nerve roots is suggestive<ref name="Rosen" />

Ostermayer: /* Suggestive */

2016-12-04T09:28:34Z

Suggestive

← Older revision		Revision as of 09:28, 4 December 2016
Line 44:		Line 44:
	**Facial flushing		**Facial flushing
	*Absence of [[fever]] at onset		*Absence of [[fever]] at onset
	*Albumin-cytological dissociation of [[CSF]] (high protein (>45) and low WBC count (<10)) is most common. However patients with HIV can have a pleocytosis<ref name="Rosen">Bunney EB, Gallagher EJ: Peripheral Nerve Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 105:p 1400-1401.</ref><ref>Brannagan TH et al. HIV-associated Guillain-Barré syndrome. J Neurol Sci. 2003;208(1-2):39. </ref>		*''Albumin-cytological dissociation of [[CSF]] (high protein (>45) and low WBC count (<10)) is most common. However patients with HIV can have a pleocytosis<ref name="Rosen">Bunney EB, Gallagher EJ: Peripheral Nerve Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 105:p 1400-1401.</ref><ref>Brannagan TH et al. HIV-associated Guillain-Barré syndrome. J Neurol Sci. 2003;208(1-2):39. </ref>''
	*Typical findings on electromyogram and nerve conduction studies		*Typical findings on electromyogram and nerve conduction studies
	*MRI: Selective enhancement of the anterior spinal nerve roots is suggestive<ref name="Rosen" />		*MRI: Selective enhancement of the anterior spinal nerve roots is suggestive<ref name="Rosen" />