View source for Guillain-Barré syndrome physical examination

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{{Guillain-Barré syndrome}}
{{CMG}}; {{AE}} {{Fs}}

==Overview==
Physical examination of patients with Guillain Barre syndrome is usually remarkable for abnormal [[gait]], [[heart rate]] and [[blood pressure]] disturbance, [[ophthalmoplegia]], [[papilledema]], facial [[myokymia]], [[vocal cord paralysis]], [[urinary retention]],  [[hyperreflexia]] or [[areflexia]], bilateral distal and proximal [[muscle weakness]] and unilateral or bilateral sensory abnormality.

==Physical Examination==
Physical examination of patients with Guillain Barre syndrome is usually remarkable for:

===Appearance of the Patient===
*Patients with Guillain Barre syndrome might have abnormal [[gait]].<ref name="pmid11320188">{{cite journal |vauthors=Mori M, Kuwabara S, Fukutake T, Yuki N, Hattori T |title=Clinical features and prognosis of Miller Fisher syndrome |journal=Neurology |volume=56 |issue=8 |pages=1104–6 |date=April 2001 |pmid=11320188 |doi= |url=}}</ref> 

===Vital Signs===

*[[Tachycardia]] or bradycardia
*[[Blood pressure]] disturbance<ref name=":1">{{Victor, M., 2001. Diseases of spinal cord peripheral nerve and muscle. Principles of Neurology}}</ref>

===Skin===
* Skin examination of patients with Guillain Barre syndrome is usually normal.
* We might see evidence of recent [[chicken pox]] disease.<ref name="pmid3404161">{{cite journal |vauthors=Winer JB, Hughes RA, Anderson MJ, Jones DM, Kangro H, Watkins RP |title=A prospective study of acute idiopathic neuropathy. II. Antecedent events |journal=J. Neurol. Neurosurg. Psychiatry |volume=51 |issue=5 |pages=613–8 |date=May 1988 |pmid=3404161 |pmc=1033063 |doi= |url=}}</ref>
===HEENT===
* Extra-ocular movements may be abnormal.<ref name="pmid11320188" />
*Ophthalmoscopic exam may be abnormal with findings of [[papilledema]].<ref name="pmid13493684">{{cite journal |vauthors=JOYNT RJ |title=Mechanism of production of papilledema in the Guillain-Barre syndrome |journal=Neurology |volume=8 |issue=1 |pages=8–12 |date=January 1958 |pmid=13493684 |doi= |url=}}</ref>
* Hearing acuity may be reduced.<ref name="pmid3399076">{{cite journal |vauthors=Nelson KR, Gilmore RL, Massey A |title=Acoustic nerve conduction abnormalities in Guillain-Barré syndrome |journal=Neurology |volume=38 |issue=8 |pages=1263–6 |date=August 1988 |pmid=3399076 |doi= |url=}}</ref>
* [[Myokymia|Facial myokymia]] (Involuntary facial movement)<ref name="pmid6681885">{{cite journal |vauthors=Mateer JE, Gutmann L, McComas CF |title=Myokymia in Guillain-Barré syndrome |journal=Neurology |volume=33 |issue=3 |pages=374–6 |date=March 1983 |pmid=6681885 |doi= |url=}}</ref>
* [[Vocal cord]] [[paralysis]] (Difficulty speaking)<ref name="pmid8441543">{{cite journal |vauthors=Panosian MS, Quatela VC |title=Guillain-Barré syndrome presenting as acute bilateral vocal cord paralysis |journal=Otolaryngol Head Neck Surg |volume=108 |issue=2 |pages=171–3 |date=February 1993 |pmid=8441543 |doi=10.1177/019459989310800211 |url=}}</ref>

===Neck===
* We might see some [[Lymphadenopathy]] because of prior infection with [[EBV]] or [[CMV]].<ref name="pmid8784256">{{cite journal |vauthors=Irie S, Saito T, Nakamura K, Kanazawa N, Ogino M, Nukazawa T, Ito H, Tamai Y, Kowa H |title=Association of anti-GM2 antibodies in Guillain-Barré syndrome with acute cytomegalovirus infection |journal=J. Neuroimmunol. |volume=68 |issue=1-2 |pages=19–26 |date=August 1996 |pmid=8784256 |doi= |url=}}</ref><ref name="pmid3404161" />
* Using accessory muscle for breathing in severe cases.
===Lungs===
* Pulmonary examination of patients with Guillain barre syndrome is usually normal.
===Heart===
* Cardiovascular examination of patients with Guillain Barre syndrome is usually normal.
===Abdomen===
* Abdominal examination of patients with Guillain Barre syndrome is usually normal.
===Back===
* Back examination of patients with Guillain Barre syndrome is usually normal.
===Genitourinary===
* Evidences of [[urinary retention]] may be present.<ref name=":1" />
===Neuromuscular===
*Patient is usually oriented to persons, place, and time.
* Altered mental status may be present.
* [[Glasgow coma scale]] is 15/ 15
* Based on the type of GBS, [[hyperreflexia]] or [[areflexia]] may be present.
* Bilateral distal and proximal muscle weakness is present.
* Reduced muscle force especially in lower extremities. 
*Unilateral or bilateral sensory abnormality especially in deep sensation in the upper/lower extremities.
*Abnormal gait is present in [[Miller Fisher Syndrome|Miller Fisher type]] of GBS.<ref name="pmid160003352">{{cite journal |vauthors=Cochen V, Arnulf I, Demeret S, Neulat ML, Gourlet V, Drouot X, Moutereau S, Derenne JP, Similowski T, Willer JC, Pierrot-Deseiligny C, Bolgert F |title=Vivid dreams, hallucinations, psychosis and REM sleep in Guillain-Barré syndrome |journal=Brain |volume=128 |issue=Pt 11 |pages=2535–45 |date=November 2005 |pmid=16000335 |doi=10.1093/brain/awh585 |url=}}</ref><ref name=":0">{{cite book | last = Mattle | first = Heinrich | title = Fundamentals of neurology : an illustrated guide | publisher = Thieme | location = Stuttgart New York | year = 2017 | isbn = 9783131364524 }}</ref><ref name="pmid12084449">{{cite journal |vauthors=Kuwabara S, Nakata M, Sung JY, Mori M, Kato N, Hattori T, Koga M, Yuki N |title=Hyperreflexia in axonal Guillain-Barré syndrome subsequent to Campylobacter jejuni enteritis |journal=J. Neurol. Sci. |volume=199 |issue=1-2 |pages=89–92 |date=July 2002 |pmid=12084449 |doi= |url=}}</ref><ref name="pmid">{{cite journal |vauthors=Kuwabara S, Ogawara K, Koga M, Mori M, Hattori T, Yuki N |title=Hyperreflexia in Guillain-Barré syndrome: relation with acute motor axonal neuropathy and anti-GM1 antibody |journal=J. Neurol. Neurosurg. Psychiatry |volume=67 |issue=2 |pages=180–4 |date=August 1999 |pmid= |pmc=1736477 |doi= |url=}}</ref><ref name=":1" />

===Extremities===
* Extremities examination of patients with Guillain Barre syndrome is usually normal.

==References==
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