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• Guillain-Barre Syndrome


  Acute inflammatory demyelinating symmetrical ascending polyneuropathy
• Guillain-Barre Syndrome


  • Preceded by URTI or diarrhea (especially campylobacter jejuni/EBV/CMV)
• Progressive ascending symmetrical distal limb weakness

  • +/- numbness
• Autonomic


  • postural hypotension
  • cardiac arrhythmias
  • ileus
  • bladder atony
• May progress to


  1. respiratory muscles

  2. respiratory failure
• May progress to


  1. facial muscles

  2. bilateral lower CN 7 palsy
• Sudden hypotension/tachycardia


  autonomic dysfunction, pulmonary embolism
• Cause of death


  • respiratory failure
  • pulmonary embolism
  • infection
• CSF


  Elevated protein, normal cells # & sugar (albumin-cytological dissociation)
• Nerve conduction studies


  • Slowing of motor conduction: most
• Antibodies against GQ1b


  Seen in Miller-Fisher syndrome (rare variant affecting CN to eye muscles→ophthalmoplegia & ataxia)
• MRI


  • Needed to exclude transverse myelitis and cord compression
• Differentials


  • Hypokalemia
  • Polymyositis
  • Myasthenia
  • Botulism
  • Poliomyelitis
• Treatment


  1. No role for steroids

  2. Mainstay: IVIg or plasma exchange

  3. ↓ duration & severity
• IVIg


  • Fewer side effects but contraindicated in pts with IgA deficiency
  • Dose is 0.4g/kg daily for 5 days
• Monitor vital capacity using PFTs


  1. Every 4 hours for respiratory distress

  2. If FVC falls below 80% predicted

  3. Transfer to ICU +/- mechanical ventilation
• Heparin


  • To prevent thrombosis
• Physiotherapy

  1. To prevent contractures

  2. NGT/PEG tube if swallowing problems