Guillain-Barre syndrome is an immune attack on the peripheral nerves, often a few weeks after a gut or respiratory infection. Weakness usually starts in the legs and climbs upward, and it can reach the breathing muscles.
Key symptoms
- Tingling in the feet and hands
- Symmetric leg weakness that spreads up to the arms
- Back or leg pain
- Trouble walking or climbing stairs
- Facial weakness, trouble swallowing or shortness of breath
What you find on exam
- Symmetric weakness, often worse in the legs
- Reduced or absent reflexes
- Facial and bulbar muscle strength
- Heart rate and blood pressure swings from autonomic involvement
- Breathing effort and ability to count in one breath
Tests
- Lumbar puncture: high protein with normal white cell count
- Nerve conduction studies and electromyography
- Forced vital capacity and negative inspiratory force, repeated often
- ECG and continuous cardiac monitoring
Treatment basics
- IV immunoglobulin or plasma exchange
- Close monitoring of breathing; intubate early if vital capacity falls
- Blood clot prevention with heparin and compression devices
- Pain control and early physical therapy
Red flags
- Vital capacity under 20 mL/kg or a weak cough
- Trouble swallowing or handling secretions
- Unstable heart rhythm or wide blood pressure swings
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.