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{{Guillain-Barré syndrome}}
{{Guillain-Barré syndrome}}


{{CMG}}; '''Associate Editors-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh@perfuse.org]
{{CMG}}; {{AE}} {{Fs}}


==Overview==
==Overview==
'''Guillain-Barré syndrome''' ('''GBS''') is an acute, autoimmune, [[neuropathy|polyradiculoneuropathy]] affecting the [[peripheral nervous system]], usually triggered by an acute infectious process. It is included in the wider group of [[peripheral neuropathy|peripheral neuropathies]]. There are several types of GBS, but unless otherwise stated, GBS refers to the most common form, acute inflammatory demyelinating polyneuropathy (AIDP). It is frequently severe and usually exhibits as an ascending paralysis noted by weakness in the legs that spreads to the upper limbs and the face along with complete loss of deep tendon reflexes. With prompt treatment of [[plasmapheresis]] followed by [[immunoglobulins]] and supportive care, the majority of patients will regain full functional capacity. However, death may occur if severe pulmonary complications and [[dysautonomia]] are present.
Patients with Guillain Barre syndrome may have a positive history of: Prior infection with [[Campylobacter jejuni]], [[Cytomegalovirus]], [[Haemophilus influenzae]], [[Epstein Barr virus|Epstein-Barr virus]], [[Varicella zoster virus]] and [[HIV]]-1, recent vaccination with influenzae or rabies vaccine, limb tingling and [[paresthesia]], lower extremity weakness and muscle pain.
==History and symptoms==


The disease is characterized by weakness which affects the lower limbs first, and rapidly progresses in an ascending fashion. Patients generally notice weakness in their legs, manifesting as "rubbery legs" or legs that tend to buckle, with or without [[dysthesias]] (numbness or tingling). As the weakness progresses upward, usually over periods of hours to days, the arms and facial muscles also become affected. Frequently, the lower [[cranial nerves]] may be affected, leading to bulbar weakness, (oropharyngeal dysphagia, that is difficulty with swallowing, drooling, and/or maintaining an open airway) and respiratory difficulties. Most patients require hospitalization and about 30% require ventilatory assistance. Facial weakness is also commonly a feature, but eye movement abnormalities are not commonly seen in ascending GBS, but are a prominent feature in the Miller-Fisher variant (see below.)
Common symptoms of Guillain Barre syndrome include: Symmetrical ascending weakness and [[paralysis]], tingling and [[paresthesia]] and pain.


Sensory loss, if present, usually takes the form of loss of [[proprioception]] (position sense) and areflexia (complete loss of deep tendon reflexes), an important feature of GBS. Loss of pain and temperature sensation is usually mild. In fact, pain is a common symptom in GBS, presenting as deep aching pain usually in the weakened muscles, which patients compare to the pain from overexercising. These pains are self-limited and should be treated with standard analgesics. Bladder dysfunction may occur in severe cases but should be transient. If severe, spinal cord disease should be suspected.
==History and Symptoms==


Fever should not be present, and if it is, another cause should be suspected.
=== History ===
* Patients with Guillain Barre syndrome may have a positive history of:
** Prior infection such as:
*** [[Campylobacter jejuni]]:<ref name="pmid9396689">{{cite journal |vauthors=Hughes RA, Rees JH |title=Clinical and epidemiologic features of Guillain-Barré syndrome |journal=J. Infect. Dis. |volume=176 Suppl 2 |issue= |pages=S92–8 |date=December 1997 |pmid=9396689 |doi= |url=}}</ref>
**** [[gastroenteritis]]
*** [[Cytomegalovirus]]:<ref name="pmid10406985">{{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=10406985 |pmc=1736477 |doi= |url=}}</ref>
**** Respiratory infection, [[mononucleosis]] and flu-like symptoms.
*** [[Haemophilus influenzae]]<ref name="pmid10214761">{{cite journal |vauthors=Mori M, Kuwabara S, Miyake M, Dezawa M, Adachi-Usami E, Kuroki H, Noda M, Hattori T |title=Haemophilus influenzae has a GM1 ganglioside-like structure and elicits Guillain-Barré syndrome |journal=Neurology |volume=52 |issue=6 |pages=1282–4 |date=April 1999 |pmid=10214761 |doi= |url=}}</ref>
*** [[Epstein Barr virus|Epstein-Barr virus]]
**** [[Mononucleosis]]
*** [[Varicella zoster virus]]<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>
**** [[Chicken pox]]
*** [[HIV]]-1<ref name="pmid3674806">{{cite journal |vauthors=Berger JR, Difini JA, Swerdloff MA, Ayyar DR |title=HIV seropositivity in Guillain-Barré syndrome |journal=Ann. Neurol. |volume=22 |issue=3 |pages=393–4 |date=September 1987 |pmid=3674806 |doi=10.1002/ana.410220320 |url=}}</ref>
** Recent vaccination:<ref name="pmid2450302">{{cite journal |vauthors=Hemachudha T, Griffin DE, Chen WW, Johnson RT |title=Immunologic studies of rabies vaccination-induced Guillain-Barré syndrome |journal=Neurology |volume=38 |issue=3 |pages=375–8 |date=March 1988 |pmid=2450302 |doi= |url=}}</ref><ref name="pmid1851395">{{cite journal |vauthors=Safranek TJ, Lawrence DN, Kurland LT, Culver DH, Wiederholt WC, Hayner NS, Osterholm MT, O'Brien P, Hughes JM |title=Reassessment of the association between Guillain-Barré syndrome and receipt of swine influenza vaccine in 1976-1977: results of a two-state study. Expert Neurology Group |journal=Am. J. Epidemiol. |volume=133 |issue=9 |pages=940–51 |date=May 1991 |pmid=1851395 |doi= |url=}}</ref>
*** [[Influenza vaccine]]
*** [[Rabies vaccine]]
** Limb tingling and [[paresthesia]]
** Lower extremity weakness<ref name=":0" />
** muscle pain<ref name="pmid9040715" />
***


In severe cases of GBS, loss of autonomic function is common, manifesting as wide fluctuations in blood pressure, [[orthostatic hypotension]], and cardiac arrhythmias.
=== Common symptoms ===
Common symptoms of Guillain Barre syndrome include:
* Most of Guillain Barre syndrome cases can be diagnosed based on partially symmetrical ascending weakness and [[paralysis]].
* Can cause sensory [[Symptom|symptoms]] such as tingling and [[paresthesia]].<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>
* Because of nerve inflammation, in the acute phase of GBS patients complain of pain.<ref name="pmid9040715">{{cite journal |vauthors=Moulin DE, Hagen N, Feasby TE, Amireh R, Hahn A |title=Pain in Guillain-Barré syndrome |journal=Neurology |volume=48 |issue=2 |pages=328–31 |date=February 1997 |pmid=9040715 |doi= |url=}}</ref>
* Some of the features may be specific to different subgroups of GBS.
** Acute inflammatory [[demyelinating]] polyneuropathy:<ref>{{Victor, M., 2001. Diseases of spinal cord peripheral nerve and muscle. Principles of Neurology}}</ref>(4)
*** It affects lower extremities first and then involves upper extremities, trunk, neck and [[cranial nerves]].
*** It can involve sensory neurons.
*** Deep sensation is the most affected sense.
*** It causes [[areflexia]]
*** In AIDP we may see [[Autonomic dysfunction|autonomic involvement]] such as changes in [[heart rate]] and [[blood pressure]] and [[urinary retention]].
** [[Acute motor axonal neuropathy]]/Acute motor and sensory axonal neuropathy:<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="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>
*** Can causes [[hyperreflexia]].
*** [[Autonomic dysfunction]] in absent or mild.
*** AMSAN can causes severe type of GBS with slow recovery
** [[Miller Fisher syndrome]]<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>
*** This type of GBS causes [[ophthalmoplegia]].
*** The reflexes are absence.
*** There is gait abnormalities ([[Ataxia]]).


Symptoms of Guillain-Barré can get worse very quickly. It may take only a few hours to reach the most severe symptoms, but [[weakness]] increasing over several days is also common.
=== Less Common Symptoms ===
 
Less common symptoms of Guillain Barre syndrome include:
[[Muscle weakness]] or the loss of [[muscle function]] ([[paralysis]]) affects both sides of the body. In most cases, the [[muscle weakness]] starts in the [[legs]] and then spreads to the arms. This is called [[ascending paralysis]].
* Symptoms of [[papilledema]] such as
 
** [[Headache]]
Patients may notice tingling, foot or hand pain, and clumsiness. If the [[inflammation]] affects the [[nerves]] to the [[diaphragm]], and there is [[weakness]] in those [[muscles]], the person may need [[breathing]] assistance.
** [[Visual disturbance]]<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>
 
* Involuntary facial movement ([[facial myokymia]])<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>
Typical symptoms include:
* Hearing loss<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>
*Loss of [[reflexes]] in the arms and legs
* Difficulty speaking (vocal cord paralysis)<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>
*[[Muscle weakness]] or loss of muscle function ([[paralysis]])
* Mental status changes<ref name="pmid16000335">{{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>
**In mild cases, there may be no [[weakness]] or [[paralysis]]
**May begin in the arms and [[legs]] at the same time
**May get worse over 24 to 72 hours
**May occur in the [[nerves]] of the [[head]] only
**May start in the arms and move downward
**May start in the [[feet]] and [[legs]] and move up to the arms and [[head]]
*[[Numbness]], decreased sensation
*Sensation changes
*[[Tenderness]] or [[muscle pain]] (may be a [[cramp]]-like [[pain]])
*Uncoordinated movement
 
Additional symptoms may include:
*[[Blurred vision]]
*Clumsiness and falling
*Difficulty moving face muscles
*Muscle contractions
*[[Palpitations]] (sensation of feeling [[heartbeat]])
 
Emergency symptoms (seek immediate medical help):
*[[Breathing]] temporarily stops
*Can't take a deep breath
*[[Difficulty breathing]]
*[[Difficulty swallowing]]
*[[Drooling]]
*[[Fainting]]
*Feeling [[light-headed]] when standing


==References==
==References==
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Latest revision as of 16:59, 27 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Overview

Patients with Guillain Barre syndrome may have a positive history of: Prior infection with Campylobacter jejuni, Cytomegalovirus, Haemophilus influenzae, Epstein-Barr virus, Varicella zoster virus and HIV-1, recent vaccination with influenzae or rabies vaccine, limb tingling and paresthesia, lower extremity weakness and muscle pain.

Common symptoms of Guillain Barre syndrome include: Symmetrical ascending weakness and paralysis, tingling and paresthesia and pain.

History and Symptoms

History

Common symptoms

Common symptoms of Guillain Barre syndrome include:

Less Common Symptoms

Less common symptoms of Guillain Barre syndrome include:

References

  1. ↑ Hughes RA, Rees JH (December 1997). "Clinical and epidemiologic features of Guillain-Barré syndrome". J. Infect. Dis. 176 Suppl 2: S92–8. PMID 9396689.
  2. ↑ Kuwabara S, Ogawara K, Koga M, Mori M, Hattori T, Yuki N (August 1999). "Hyperreflexia in Guillain-Barré syndrome: relation with acute motor axonal neuropathy and anti-GM1 antibody". J. Neurol. Neurosurg. Psychiatry. 67 (2): 180–4. PMC 1736477. PMID 10406985.
  3. ↑ Mori M, Kuwabara S, Miyake M, Dezawa M, Adachi-Usami E, Kuroki H, Noda M, Hattori T (April 1999). "Haemophilus influenzae has a GM1 ganglioside-like structure and elicits Guillain-Barré syndrome". Neurology. 52 (6): 1282–4. PMID 10214761.
  4. ↑ Winer JB, Hughes RA, Anderson MJ, Jones DM, Kangro H, Watkins RP (May 1988). "A prospective study of acute idiopathic neuropathy. II. Antecedent events". J. Neurol. Neurosurg. Psychiatry. 51 (5): 613–8. PMC 1033063. PMID 3404161.
  5. ↑ Berger JR, Difini JA, Swerdloff MA, Ayyar DR (September 1987). "HIV seropositivity in Guillain-Barré syndrome". Ann. Neurol. 22 (3): 393–4. doi:10.1002/ana.410220320. PMID 3674806.
  6. ↑ Hemachudha T, Griffin DE, Chen WW, Johnson RT (March 1988). "Immunologic studies of rabies vaccination-induced Guillain-Barré syndrome". Neurology. 38 (3): 375–8. PMID 2450302.
  7. ↑ Safranek TJ, Lawrence DN, Kurland LT, Culver DH, Wiederholt WC, Hayner NS, Osterholm MT, O'Brien P, Hughes JM (May 1991). "Reassessment of the association between Guillain-Barré syndrome and receipt of swine influenza vaccine in 1976-1977: results of a two-state study. Expert Neurology Group". Am. J. Epidemiol. 133 (9): 940–51. PMID 1851395.
  8. ↑ 8.0 8.1 Mattle, Heinrich (2017). Fundamentals of neurology : an illustrated guide. Stuttgart New York: Thieme. ISBN 9783131364524.
  9. ↑ 9.0 9.1 Moulin DE, Hagen N, Feasby TE, Amireh R, Hahn A (February 1997). "Pain in Guillain-Barré syndrome". Neurology. 48 (2): 328–31. PMID 9040715.
  10. ↑ Template:Victor, M., 2001. Diseases of spinal cord peripheral nerve and muscle. Principles of Neurology
  11. ↑ Kuwabara S, Ogawara K, Koga M, Mori M, Hattori T, Yuki N (August 1999). "Hyperreflexia in Guillain-Barré syndrome: relation with acute motor axonal neuropathy and anti-GM1 antibody". J. Neurol. Neurosurg. Psychiatry. 67 (2): 180–4. PMC 1736477.
  12. ↑ Kuwabara S, Nakata M, Sung JY, Mori M, Kato N, Hattori T, Koga M, Yuki N (July 2002). "Hyperreflexia in axonal Guillain-Barré syndrome subsequent to Campylobacter jejuni enteritis". J. Neurol. Sci. 199 (1–2): 89–92. PMID 12084449.
  13. ↑ Mori M, Kuwabara S, Fukutake T, Yuki N, Hattori T (April 2001). "Clinical features and prognosis of Miller Fisher syndrome". Neurology. 56 (8): 1104–6. PMID 11320188.
  14. ↑ JOYNT RJ (January 1958). "Mechanism of production of papilledema in the Guillain-Barre syndrome". Neurology. 8 (1): 8–12. PMID 13493684.
  15. ↑ Mateer JE, Gutmann L, McComas CF (March 1983). "Myokymia in Guillain-Barré syndrome". Neurology. 33 (3): 374–6. PMID 6681885.
  16. ↑ Nelson KR, Gilmore RL, Massey A (August 1988). "Acoustic nerve conduction abnormalities in Guillain-Barré syndrome". Neurology. 38 (8): 1263–6. PMID 3399076.
  17. ↑ Panosian MS, Quatela VC (February 1993). "Guillain-Barré syndrome presenting as acute bilateral vocal cord paralysis". Otolaryngol Head Neck Surg. 108 (2): 171–3. doi:10.1177/019459989310800211. PMID 8441543.
  18. ↑ 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 (November 2005). "Vivid dreams, hallucinations, psychosis and REM sleep in Guillain-Barré syndrome". Brain. 128 (Pt 11): 2535–45. doi:10.1093/brain/awh585. PMID 16000335.

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