Guillain-Barré syndrome physical examination: Difference between revisions
| Line 48: | Line 48: | ||
* Disease course < 4 weeks | * Disease course < 4 weeks | ||
* Exclusion of other causes (see below) | * 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== | ||
Revision as of 16:07, 28 February 2013
|
Guillain-Barré syndrome Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Guillain-Barré syndrome physical examination On the Web |
|
American Roentgen Ray Society Images of Guillain-Barré syndrome physical examination |
|
Risk calculators and risk factors for Guillain-Barré syndrome physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [2]
Overview
It is included in the wider group of 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
The findings on physical examination indicates features of autonomic dysfunction and weakness of respiratory muscles
Vitals
Temperature
- Hyperthermia or hypothermia either could be present.
Pulse
Rate
- Tachycardia or bradycardia may be observed
Blood Pressure
- Hypertension or hypotension can be observed.
Respiratory Rate
- Tachypnea due to respiratory failure could be observed.
Neurologic
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
Nutrition
The muscle bulk is normal earlier in the course of the disease. However, later with disease progression muscle atrophy may be found.
Tone
- Hypotonia may be seen associated with severe weakness
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
- 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.
Reflexes
Hyporeflexia or Areflexia can be commonly seen
Diagnostic Criteria
Required
- 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