Guillain-Barré syndrome physical examination

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

Overview

Guillain-Barré syndrome (GBS) is an acute, autoimmune, polyradiculoneuropathy affecting the peripheral nervous system, usually triggered by an acute infectious process. It is included in the wider group of 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.

Physical examination

General physical examination

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 involved.
• Other findings like dysphagia (cranial nerve IX, X, and XI), dysarthria (cranial nerve X), and ocular muscle palsy (VI), Ptosis (III}, Pupillary abnormalities (Tonic pupils) (II) may be 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