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Patient may present with an antecedence of mild [[infection]] of respiratory or gastrointestinal infections that may disappear before the onset of [[weakness]]. Many patients also give a history of pins and needles sensation before the onset of weakness of limbs. Symmetrical, bilateral, weakness of lower limbs followed by upper limb, trunk and [[cranial nerve]] may be seen. Sensory symptoms are usually mild and patients may complain of decreased or increased pain sensation, decreased touch and difficulty walking (loss of position sense) depending on stage and type of GBS. Autonomic involvement in form of [[urinary retention]], [[constipation]] and awareness of own's heartbeat can be found. [[Cranial nerve]] involvement in form of blurred vision, facial drooping, difficulty in swallowing and speaking can be seen.
Patient may present with an antecedence of mild [[infection]] of respiratory or gastrointestinal infections that may disappear before the onset of [[weakness]]. Many patients also give a history of pins and needles sensation before the onset of weakness of limbs. Symmetrical, bilateral, weakness of lower limbs followed by upper limb, trunk and [[cranial nerve]] may be seen. Sensory symptoms are usually mild and patients may complain of decreased or increased pain sensation, decreased touch and difficulty walking (loss of position sense) depending on stage and type of GBS. Autonomic involvement in form of [[urinary retention]], [[constipation]] and awareness of own's heartbeat can be found. [[Cranial nerve]] involvement in form of blurred vision, facial drooping, difficulty in swallowing and speaking can be seen.


==History==
==History and Symptoms==
 
=== 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 <ref name="pmid19709434">{{cite journal |author=Nelson L, Gormley R, Riddle MS, Tribble DR, Porter CK |title=The epidemiology of Guillain-Barré Syndrome in U.S. military personnel: a case-control study |journal=[[BMC Research Notes]] |volume=2 |issue= |pages=171 |year=2009 |pmid=19709434 |pmc=2739856 |doi=10.1186/1756-0500-2-171 |url=http://www.biomedcentral.com/1756-0500/2/171 |accessdate=2012-02-23}}</ref>. However, these infections usually resolve before onset of weakness.
* Patients may present with a history of antecedence benign infection of gut or respiratory tract, 2-4 weeks prior to the development of symptoms <ref name="pmid19709434">{{cite journal |author=Nelson L, Gormley R, Riddle MS, Tribble DR, Porter CK |title=The epidemiology of Guillain-Barré Syndrome in U.S. military personnel: a case-control study |journal=[[BMC Research Notes]] |volume=2 |issue= |pages=171 |year=2009 |pmid=19709434 |pmc=2739856 |doi=10.1186/1756-0500-2-171 |url=http://www.biomedcentral.com/1756-0500/2/171 |accessdate=2012-02-23}}</ref>. However, these infections usually resolve before onset of weakness.
* 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.
* 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.
Line 15: Line 17:
* Recovery usually starts 2-4 weeks after the progression of symptoms ceases <ref name="pmid17709995">{{cite journal |author=El Mhandi L, Calmels P, Camdessanché JP, Gautheron V, Féasson L |title=Muscle strength recovery in treated Guillain-Barré syndrome: a prospective study for the first 18 months after onset |journal=[[American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists]] |volume=86 |issue=9 |pages=716–24 |year=2007 |month=September |pmid=17709995 |doi=10.1097/PHM.0b013e31813e0b67 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0894-9115&volume=86&issue=9&spage=716 |accessdate=2012-02-23}}</ref>.
* Recovery usually starts 2-4 weeks after the progression of symptoms ceases <ref name="pmid17709995">{{cite journal |author=El Mhandi L, Calmels P, Camdessanché JP, Gautheron V, Féasson L |title=Muscle strength recovery in treated Guillain-Barré syndrome: a prospective study for the first 18 months after onset |journal=[[American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists]] |volume=86 |issue=9 |pages=716–24 |year=2007 |month=September |pmid=17709995 |doi=10.1097/PHM.0b013e31813e0b67 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0894-9115&volume=86&issue=9&spage=716 |accessdate=2012-02-23}}</ref>.
* The mean time to clinical recovery is 15-20 weeks
* The mean time to clinical recovery is 15-20 weeks
==Symptoms==
* [[Fever]] is uncommon and if it is present, another cause should be suspected.
* The initial symptoms in many patients may be [[tingling]], [[numbness]] or [[clumsiness]] sensation of the hands and foot.
* These may start with fingertips and toes and can progress to wrist and ankles but not further.
===Motor===
* The initial symptoms may be followed by development of weakness. The weakness may be characterized by the following features:
** It 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.
** Patients generally notice weakness in their legs, manifesting as "rubbery legs" or legs that tend to buckle easily.
** '''Proximal muscles''' are affected more commonly and earlier than distal muscles. The patient may presents with difficulty in standing from sitting position and walking
** The weakness usually affects both sides of the body ('''bilateral, symmetrical''').
** It may rarely begin in the arms and [[legs]] at the same time
** It may rarely start in the arms and move downward
** In mild cases, there may be no [[weakness]] or [[paralysis]]
* Respiratory difficulties presenting secondary to respiratory muscle weakness may be seen. Most patients require hospitalization and about 30% require ventilatory assistance.
===Sensory===
* Loss of touch, difficulty walking (position sense), pain and temperature sensation may present. Loss of pain and temperature sensation is usually mild.
* On contrary, patient may present with deep aching pain usually in the weakened muscles, which they compare to the pain from overexercising. The causes for the pain are uncertain however, nerve injury and prolonged immobilization can be considered as possible causes
* The common sites for pain are: Shoulder, back, thigh and buttock
===Autonomic===
* Dizziness on standing from sitting or lying position ([[orthostatic hypotension]])
* Awareness of self heartbeat ([[Palpitations]])
* Increased or no sweating.
* Difficulty or urinary retention.
* [[Constipation]] secondary to bowel paralysis.


===Cranial Nerve===
=== Common symptoms ===
* Usually symptoms due to involvement of cranial nerves follows weakness of limbs and trunk. However, in the [[Miller-Fisher variant]] of GBS cranial nerve are the first to get involved followed by limb involvement <ref name="pmid17657801">{{cite journal |author=Lo YL |title=Clinical and immunological spectrum of the Miller Fisher syndrome |journal=[[Muscle & Nerve]] |volume=36 |issue=5 |pages=615–27 |year=2007 |month=November |pmid=17657801 |doi=10.1002/mus.20835 |url=http://dx.doi.org/10.1002/mus.20835 |accessdate=2012-02-23}}</ref>.
* Most of Guillain Barre syndrome cases can be diagnosed based on partially symmetrical ascending weakness and paralysis.
* [[Blurred vision]], [[double vision]]
* Can cause sensory symptoms such as tingling and paresthesia. (az fundamental)
* Eye movement abnormalities are not commonly seen in ascending GBS, but are a prominent feature in the Miller-Fisher variant
* Some of the features may be specific to different subgroups of GBS.  
* Difficulty in swallowing speaking and drooling of saliva.
** Acute inflammatory demyelinating polyneuropathy:(4)
* Facial weakness may also be seen.
*** It affects lower extremities first and then involves upper extremities, trunk, neck and cranial nerves.
* Uncoordinated movements presenting as clumsiness in walking and history of fall may be seen.
*** It can involve sensory neurons.
*** Deep sensation is the most affected sense.
*** It causes areflexia
*** In AIDP we may see autonomic involvement such as changes in heart rate and blood pressure and urinary retention.
** Acute motor axonal neuropathy/Acute motor and sensory axonal neuropathy:(43_44)
*** Can causes hyperreflexia.
*** Autonomic dysfunction in absent or mild.
*** AMSAN can causes severe type of GBS with slow recovery
** Miller Fisher syndrome(7)
*** This type of GBS causes ophthalmoplegia.
*** The reflexes are absence.
*** There is gait abnormalities (Ataxia).


===Emergency Symptoms===
=== Less Common Symptoms ===
*[[Difficulty breathing]]
* Papilledema
*[[Difficulty swallowing]]
* Facial myokymia
*[[Drooling]]
* Hearing loss
*[[Fainting]]
* Meningeal signs
*Feeling [[light-headed]] when standing
* Vocal cord paralysis
* Mental status changes


==References==
==References==

Revision as of 16:10, 17 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, MBBS [2]

Overview

Patient may present with an antecedence of mild infection of respiratory or gastrointestinal infections that may disappear before the onset of weakness. Many patients also give a history of pins and needles sensation before the onset of weakness of limbs. Symmetrical, bilateral, weakness of lower limbs followed by upper limb, trunk and cranial nerve may be seen. Sensory symptoms are usually mild and patients may complain of decreased or increased pain sensation, decreased touch and difficulty walking (loss of position sense) depending on stage and type of GBS. Autonomic involvement in form of urinary retention, constipation and awareness of own's heartbeat can be found. Cranial nerve involvement in form of blurred vision, facial drooping, difficulty in swallowing and speaking can be seen.

History and Symptoms

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 [1]. However, these infections usually resolve before onset of weakness.
  • 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 [2].
  • Recovery usually starts 2-4 weeks after the progression of symptoms ceases [3].
  • The mean time to clinical recovery is 15-20 weeks

Common symptoms

  • Most of Guillain Barre syndrome cases can be diagnosed based on partially symmetrical ascending weakness and paralysis.
  • Can cause sensory symptoms such as tingling and paresthesia. (az fundamental)
  • Some of the features may be specific to different subgroups of GBS.
    • Acute inflammatory demyelinating polyneuropathy:(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 involvement such as changes in heart rate and blood pressure and urinary retention.
    • Acute motor axonal neuropathy/Acute motor and sensory axonal neuropathy:(43_44)
      • Can causes hyperreflexia.
      • Autonomic dysfunction in absent or mild.
      • AMSAN can causes severe type of GBS with slow recovery
    • Miller Fisher syndrome(7)
      • This type of GBS causes ophthalmoplegia.
      • The reflexes are absence.
      • There is gait abnormalities (Ataxia).

Less Common Symptoms

  • Papilledema
  • Facial myokymia
  • Hearing loss
  • Meningeal signs
  • Vocal cord paralysis
  • Mental status changes

References

  1. ↑ Nelson L, Gormley R, Riddle MS, Tribble DR, Porter CK (2009). "The epidemiology of Guillain-Barré Syndrome in U.S. military personnel: a case-control study". BMC Research Notes. 2: 171. doi:10.1186/1756-0500-2-171. PMC 2739856. PMID 19709434. Retrieved 2012-02-23.
  2. ↑ Hughes RA, Rees JH (1997). "Clinical and epidemiologic features of Guillain-Barré syndrome". The Journal of Infectious Diseases. 176 Suppl 2: S92–8. PMID 9396689. Retrieved 2012-02-23. Unknown parameter |month= ignored (help)
  3. ↑ El Mhandi L, Calmels P, Camdessanché JP, Gautheron V, Féasson L (2007). "Muscle strength recovery in treated Guillain-Barré syndrome: a prospective study for the first 18 months after onset". American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 86 (9): 716–24. doi:10.1097/PHM.0b013e31813e0b67. PMID 17709995. Retrieved 2012-02-23. Unknown parameter |month= ignored (help)

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