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__NOTOC__
{{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.  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==
Common symptoms of Guillain Barre syndrome include: Symmetrical ascending weakness and [[paralysis]], tingling and [[paresthesia]] and pain.
===History===
* Patients may present with a history of antecedence benign infection of gut or respiratory tract, 2-4 weeks prior to the development of symptoms.
* Symptoms can get worse very quickly. It may take only a few hours to reach the most severe symptoms, however [[weakness]] increasing over several days is also common.
* The mean time to the clinical function peak is 2 weeks, with most of the patients reaching a nadir by 4 weeks.
* This is usually followed by a plateau phase characterized by persistent, unchanging symptoms.
* The plateau phase may last for days before initiation of gradual symptoms improvement.
* Recovery usually starts 2-4 weeks after the progression of symptoms ceases.
* The mean time to clinical recovery is 15-20 weeks


===Symptoms===
==History and Symptoms==
* [[Fever]] is uncommon and, and if it is present, another cause should be suspected. The initial symptoms in many patients may be [[tingling]], [[numbness]], [[pain]] or [[clumsiness]] sensation of the hands and foot.
 
====Motor====
=== History ===
* These initial symptoms may be followed by development of weakness. The weakness may be characterized by the following features:
* Patients with Guillain Barre syndrome may have a positive history of:
** The weakness usually affects the legs first, and rapidly progresses (hours to days) in an ascending fashion to involve trunk, upper limb, face, and other parts of the body.
** Prior infection such as:
** Patients generally notice weakness in their legs, manifesting as "rubbery legs" or legs that tend to buckle easily.
*** [[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>
** In mild cases, there may be no [[weakness]] or [[paralysis]]
**** [[gastroenteritis]]
** The weakness usually affects both sides of the body.
*** [[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>
** It may begin in the arms and [[legs]] at the same time
**** Respiratory infection, [[mononucleosis]] and flu-like symptoms.
** It may rarely start in the arms and move downward
*** [[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>
* Respiratory difficulties secondary to respiratory muscle weakness may be seen. Most patients require hospitalization and about 30% require ventilatory assistance.
*** [[Epstein Barr virus|Epstein-Barr virus]]
====Sensory====
**** [[Mononucleosis]]
* Loss of position sense, pain and temperature sensation may present. 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.
*** [[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>
====Autonomic====
**** [[Chicken pox]]
* Dizziness on standing from sitting or lying position (orthostatic hypotension) and sensation of feeling [[heartbeat]]) [[Palpitations]] (autonomic involvement)
*** [[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>
====Cranial nerve====
** 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>
* [[Blurred vision]]
*** [[Influenza vaccine]]
* Eye movement abnormalities are not commonly seen in ascending GBS, but are a prominent feature in the Miller-Fisher variant
*** [[Rabies vaccine]]
* Difficulty in swallowing, drooling,
** Limb tingling and [[paresthesia]]
* Facial weakness is also commonly a feature.
** Lower extremity weakness<ref name=":0" />
*Uncoordinated movement. Clumsiness and falling
** muscle pain<ref name="pmid9040715" />
===Emergency symptoms (seek immediate medical help)===
***
*[[Difficulty breathing]]
 
*[[Difficulty swallowing]]
=== Common symptoms ===
*[[Drooling]]
Common symptoms of Guillain Barre syndrome include:
*[[Fainting]]
* Most of Guillain Barre syndrome cases can be diagnosed based on partially symmetrical ascending weakness and [[paralysis]].  
*Feeling [[light-headed]] when standing
* 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]]).
 
=== Less Common Symptoms ===
Less common symptoms of Guillain Barre syndrome include:
* Symptoms of [[papilledema]] such as
** [[Headache]]
** [[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>
* 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>
* 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>
* 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>


==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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