Guillain-Barre Syndrome

Excerpt

Guillain-Barré syndrome (GBS) is a relatively rare, acute, inflammatory, immune-mediated, potentially fatal disease of the nerve roots and peripheral nerves. This globally recognized neuromuscular emergency is the most common cause of nonpoliovirus-associated acute flaccid paralysis. Typically, GBS presents as an ascending, symmetric sensorimotor variant, beginning with distal paresthesias and progressing to lower-extremity weakness before spreading to the upper extremities and cranial nerves.

However, the disease exhibits a broad phenotypic spectrum. Symptoms typically begin about 10 days after an antecedent trigger, often an infection, and reach a nadir within 2 weeks. A nadir within 24 hours or progression beyond 4 weeks should raise suspicion for an alternative diagnosis. The disease usually plateaus in 1 to 4 weeks.

Intravenous immunoglobulin and plasma exchange are equally efficacious treatments for GBS. This condition is typically monophasic, but patients may experience treatment-related fluctuations. Respiratory insufficiency and cardiovascular compromise are the most critical complications that may require care in an intensive care unit (ICU).

Some complications are hospital-acquired, such as infections. Patients with bulbar palsy have swallowing difficulty, and those with facial palsy may develop corneal ulceration. Extremity weakness may lead to contractures, and prolonged immobility may result in deep venous thrombosis. Autonomic dysfunction may manifest with bowel and bladder dysfunction. Pain, anxiety, and hallucinations are often underrecognized and undertreated, especially when patients have difficulty communicating or are in the ICU. Interprofessional management of complications is important and should include clinicians, nurses, occupational therapists, physical therapists, speech therapists, and dietitians.