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


{{CMG}}; '''Associate Editors-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh13579@gmail.com]
==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.


==Overview==
==Physical Examination==
It is included in the wider group of [[peripheral neuropathy|peripheral neuropathies]]. The physical examination findings usually indicates features due to [[autonomic dysfunction]] and [[demyelination]] of [[peripheral nerves]]. Fluctuation in vitals can be seen and may present as hyper or hypothermia, hypo or hypertension, brady or tachycardia. Progressive, symmetric, bilateral, flaccid, ascending paralysis progressing over weeks to days time is the common finding. Hypotonia, hyporeflexia, areflexia can be seen.[[Sensory]] system may be involved but generally it is mild. [[Ataxia]] and difficulty in walking may be seen despite great muscle strength due to involvement of [[proprioception]] and [[oculoparesis]].
Physical examination of patients with Guillain Barre syndrome is usually remarkable for:


==Physical examination==
===Appearance of the Patient===
===General physical examination===
*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>
The findings on physical examination indicates features of autonomic dysfunction and weakness of respiratory muscles
====Vitals====
* [[Hyperthermia]] or [[hypothermia]] either could be present.
* [[Tachypnea]] due to respiratory failure could be observed.
* [[Tachycardia]] or [[bradycardia]] may be observed
* [[Hypertension]] or [[hypotension]] can be observed.
===Neurological examination===
====Cranial nerve====
* Facial palsy (cranial nerve VII involvement) is the most commonly found.
* Other findings like [[dysphagia]] (cranial nerve IX, X, and XI), [[dysarthria]] (cranial nerve X), [[ocular muscle palsy]] (VI), [[Ptosis]] (III}, and [[Pupillary abnormalities]] ([[Tonic pupils]]) (II) may be seen.


====Motor system====
===Vital Signs===
=====Nutrition=====
The muscle bulk is normal earlier in the course of the disease. However, later with disease progression muscle atrophy may be found.


=====Tone=====
*[[Tachycardia]] or bradycardia
* Hypotonia may be seen associated with severe weakness
*[[Blood pressure]] disturbance<ref name=":1">{{Victor, M., 2001. Diseases of spinal cord peripheral nerve and muscle. Principles of Neurology}}</ref>
=====Power=====
* Progressive, symmetrical, ascending palsy involving proximal muscles earlier than distal muscles are the most common findings.
* The weakness usually starts with lower limb followed by trunk, upper limb, and cranial nerve. In [[Miller-Fischer]] variant though [[cranial nerves]] are involved earlier than the limbs.
=====Coordination=====
* The patient may have difficulty walking despite having a good power. This may be due to involvement of proprioceptive and ocular muscles.


====Sensory system====
===Skin===
* Though the first presenting symptoms may be [[dysthesia]], severe [[sensory]] involvement is unusal. A definitive sensory level findings put the diagnosis of [[GBS]] into question.
* 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>


====Reflexes====
===Neck===
[[Hyporeflexia]] or [[Areflexia]] can be commonly seen
* 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" />


===Diagnostic criteria===
===Extremities===
* '''Required'''
* Extremities examination of patients with Guillain Barre syndrome is usually normal.
** Progressive, relatively symmetrical weakness of 2 or more limbs due to neuropathy
** Areflexia
** Disease course < 4 weeks
** Exclusion of other causes (see below)
* '''Supportive'''
** relatively symmetric weakness accompanied by numbness and/or tingling
** mild sensory involvement
** facial nerve or other cranial nerve involvement
** absence of fever
** typical CSF findings obtained from lumbar puncture
** electrophysiologic evidence of demyelination from electromyogram


==References==
==References==
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Latest revision as of 17:04, 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

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.[1]

Vital Signs

Skin

  • Skin examination of patients with Guillain Barre syndrome is usually normal.
  • We might see evidence of recent chicken pox disease.[3]

HEENT

Neck

  • We might see some Lymphadenopathy because of prior infection with EBV or CMV.[8][3]
  • 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

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 type of GBS.[9][10][11][12][2]

Extremities

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

References

  1. ↑ 1.0 1.1 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.
  2. ↑ 2.0 2.1 2.2 Template:Victor, M., 2001. Diseases of spinal cord peripheral nerve and muscle. Principles of Neurology
  3. ↑ 3.0 3.1 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.
  4. ↑ JOYNT RJ (January 1958). "Mechanism of production of papilledema in the Guillain-Barre syndrome". Neurology. 8 (1): 8–12. PMID 13493684.
  5. ↑ Nelson KR, Gilmore RL, Massey A (August 1988). "Acoustic nerve conduction abnormalities in Guillain-Barré syndrome". Neurology. 38 (8): 1263–6. PMID 3399076.
  6. ↑ Mateer JE, Gutmann L, McComas CF (March 1983). "Myokymia in Guillain-Barré syndrome". Neurology. 33 (3): 374–6. PMID 6681885.
  7. ↑ 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.
  8. ↑ Irie S, Saito T, Nakamura K, Kanazawa N, Ogino M, Nukazawa T, Ito H, Tamai Y, Kowa H (August 1996). "Association of anti-GM2 antibodies in Guillain-Barré syndrome with acute cytomegalovirus infection". J. Neuroimmunol. 68 (1–2): 19–26. PMID 8784256.
  9. ↑ 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.
  10. ↑ Mattle, Heinrich (2017). Fundamentals of neurology : an illustrated guide. Stuttgart New York: Thieme. ISBN 9783131364524.
  11. ↑ 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.
  12. ↑ 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.

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