Guillain-Barré syndrome physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.


Physical examination of patients with Guillain Barre syndrome is usually remarkable for abnormal gait, heart rate and blood pressure disturbance, ophthalmoplegia, papilledema, facial myokymia, vocal cord paralysis, urinary retention, hyperreflexia or areflexia, bilateral distal and proximal muscle weakness and unilateral or bilateral sensory abnormality.

Physical Examination

Physical examination of patients with Guillain Barre syndrome is usually remarkable for:

Appearance of the Patient

  • Patients with Guillain Barre syndrome might have abnormal gait.[1]

Vital Signs


  • Skin examination of patients with Guillain Barre syndrome is usually normal.
  • We might see evidence of recent chicken pox disease.[3]



  • We might see some Lymphadenopathy because of prior infection with EBV or CMV.[8][3]
  • Using accessory muscle for breathing in severe cases.


  • Pulmonary examination of patients with Guillain barre syndrome is usually normal.


  • Cardiovascular examination of patients with Guillain Barre syndrome is usually normal.


  • Abdominal examination of patients with Guillain Barre syndrome is usually normal.


  • Back examination of patients with Guillain Barre syndrome is usually normal.



  • Patient is usually oriented to persons, place, and time.
  • Altered mental status may be present.
  • Glasgow coma scale is 15/ 15
  • Based on the type of GBS, hyperreflexia or areflexia may be present.
  • Bilateral distal and proximal muscle weakness is present.
  • Reduced muscle force especially in lower extremities.
  • Unilateral or bilateral sensory abnormality especially in deep sensation in the upper/lower extremities.
  • Abnormal gait is present in Miller Fisher type of GBS.[9][10][11][12][2]


  • Extremities examination of patients with Guillain Barre syndrome is usually normal.


  1. 1.0 1.1 Mori M, Kuwabara S, Fukutake T, Yuki N, Hattori T (April 2001). "Clinical features and prognosis of Miller Fisher syndrome". Neurology. 56 (8): 1104–6. PMID 11320188.
  2. 2.0 2.1 2.2 Template:Victor, M., 2001. Diseases of spinal cord peripheral nerve and muscle. Principles of Neurology
  3. 3.0 3.1 Winer JB, Hughes RA, Anderson MJ, Jones DM, Kangro H, Watkins RP (May 1988). "A prospective study of acute idiopathic neuropathy. II. Antecedent events". J. Neurol. Neurosurg. Psychiatry. 51 (5): 613–8. PMC 1033063. PMID 3404161.
  4. JOYNT RJ (January 1958). "Mechanism of production of papilledema in the Guillain-Barre syndrome". Neurology. 8 (1): 8–12. PMID 13493684.
  5. Nelson KR, Gilmore RL, Massey A (August 1988). "Acoustic nerve conduction abnormalities in Guillain-Barré syndrome". Neurology. 38 (8): 1263–6. PMID 3399076.
  6. Mateer JE, Gutmann L, McComas CF (March 1983). "Myokymia in Guillain-Barré syndrome". Neurology. 33 (3): 374–6. PMID 6681885.
  7. Panosian MS, Quatela VC (February 1993). "Guillain-Barré syndrome presenting as acute bilateral vocal cord paralysis". Otolaryngol Head Neck Surg. 108 (2): 171–3. doi:10.1177/019459989310800211. PMID 8441543.
  8. Irie S, Saito T, Nakamura K, Kanazawa N, Ogino M, Nukazawa T, Ito H, Tamai Y, Kowa H (August 1996). "Association of anti-GM2 antibodies in Guillain-Barré syndrome with acute cytomegalovirus infection". J. Neuroimmunol. 68 (1–2): 19–26. PMID 8784256.
  9. Cochen V, Arnulf I, Demeret S, Neulat ML, Gourlet V, Drouot X, Moutereau S, Derenne JP, Similowski T, Willer JC, Pierrot-Deseiligny C, Bolgert F (November 2005). "Vivid dreams, hallucinations, psychosis and REM sleep in Guillain-Barré syndrome". Brain. 128 (Pt 11): 2535–45. doi:10.1093/brain/awh585. PMID 16000335.
  10. Mattle, Heinrich (2017). Fundamentals of neurology : an illustrated guide. Stuttgart New York: Thieme. ISBN 9783131364524.
  11. Kuwabara S, Nakata M, Sung JY, Mori M, Kato N, Hattori T, Koga M, Yuki N (July 2002). "Hyperreflexia in axonal Guillain-Barré syndrome subsequent to Campylobacter jejuni enteritis". J. Neurol. Sci. 199 (1–2): 89–92. PMID 12084449.
  12. Kuwabara S, Ogawara K, Koga M, Mori M, Hattori T, Yuki N (August 1999). "Hyperreflexia in Guillain-Barré syndrome: relation with acute motor axonal neuropathy and anti-GM1 antibody". J. Neurol. Neurosurg. Psychiatry. 67 (2): 180–4. PMC 1736477.

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