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{{Guillain-Barré syndrome}}
{{Guillain-Barré syndrome}}


{{CMG}}; '''Associate Editors-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh@perfuse.org]
{{CMG}}; {{AE}} {{Fs}}


==Overview==
==Overview==
'''Guillain-Barré syndrome''' ('''GBS''') is an acute, autoimmune, [[neuropathy|polyradiculoneuropathy]] affecting the [[peripheral nervous system]], usually triggered by an acute infectious process. It is included in the wider group of [[peripheral neuropathy|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.  However, death may occur if severe pulmonary complications and [[dysautonomia]] are present.
Patients with Guillain Barre syndrome may have a positive history of: Prior infection with [[Campylobacter jejuni]], [[Cytomegalovirus]], [[Haemophilus influenzae]], [[Epstein Barr virus|Epstein-Barr virus]], [[Varicella zoster virus]] and [[HIV]]-1, recent vaccination with influenzae or rabies vaccine, limb tingling and [[paresthesia]], lower extremity weakness and muscle pain.


==History and symptoms==
Common symptoms of Guillain Barre syndrome include: Symmetrical ascending weakness and [[paralysis]], tingling and [[paresthesia]] and pain.
===History===
* Patients may present with a history of antecedence benign infection of gut or respiratory tract, 2-4 weeks prior to the development of symptoms.
* Symptoms can get worse very quickly. It may take only a few hours to reach the most severe symptoms, however [[weakness]] increasing over several days is also common.
* The mean time to the clinical function peak is 2 weeks, with most of the patients reaching a nadir by 4 weeks.
* This is usually followed by a plateau phase characterized by persistent, unchanging symptoms.
* The plateau phase may last for days before initiation of gradual symptoms improvement <ref name="pmid9396689">{{cite journal |author=Hughes RA, Rees JH |title=Clinical and epidemiologic features of Guillain-Barré syndrome |journal=[[The Journal of Infectious Diseases]] |volume=176 Suppl 2 |issue= |pages=S92–8 |year=1997 |month=December |pmid=9396689 |doi= |url=http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=9396689 |accessdate=2012-02-23}}</ref>.
* Recovery usually starts 2-4 weeks after the progression of symptoms ceases <ref name="pmid17709995">{{cite journal |author=El Mhandi L, Calmels P, Camdessanché JP, Gautheron V, Féasson L |title=Muscle strength recovery in treated Guillain-Barré syndrome: a prospective study for the first 18 months after onset |journal=[[American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists]] |volume=86 |issue=9 |pages=716–24 |year=2007 |month=September |pmid=17709995 |doi=10.1097/PHM.0b013e31813e0b67 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0894-9115&volume=86&issue=9&spage=716 |accessdate=2012-02-23}}</ref>.
* The mean time to clinical recovery is 15-20 weeks


===Symptoms===
==History and Symptoms==
* [[Fever]] is uncommon and, and if it is present, another cause should be suspected.
* The initial symptoms in many patients may be [[tingling]], [[numbness]] or [[clumsiness]] sensation of the hands and foot.
* These may start with fingertips and toes and can progress to wrist and ankles but not further.
====Motor====
* The initial symptoms may be followed by development of weakness. The weakness may be characterized by the following features:
** It usually affects the legs first, and rapidly progresses (hours to days) in an '''ascending fashion''' to involve trunk, upper limb, face, and other parts of the body.
** Patients generally notice weakness in their legs, manifesting as "rubbery legs" or legs that tend to buckle easily.
** '''Proximal muscles''' are affected more commonly and earlier than distal muscles. The patient may presents with difficulty in standing from sitting position and walking
** The weakness usually affects both sides of the body ('''bilateral, symmetrical''').
** It may rarely begin in the arms and [[legs]] at the same time
** It may rarely start in the arms and move downward
** In mild cases, there may be no [[weakness]] or [[paralysis]]
* Respiratory difficulties presenting secondary to respiratory muscle weakness may be seen. Most patients require hospitalization and about 30% require ventilatory assistance.


====Sensory====
=== History ===
* Loss of touch, position sense, pain and temperature sensation may present. Loss of pain and temperature sensation is usually mild.
* Patients with Guillain Barre syndrome may have a positive history of:
* On contrary, patient may present with deep aching pain usually in the weakened muscles, which they compare to the pain from overexercising. The causes for the pain are uncertain however, nerve injury and prolonged immobilization can be considered as possible causes
** Prior infection such as:
* The common sites for pain are: Shoulder, back, thigh and buttock
*** [[Campylobacter jejuni]]:<ref name="pmid9396689">{{cite journal |vauthors=Hughes RA, Rees JH |title=Clinical and epidemiologic features of Guillain-Barré syndrome |journal=J. Infect. Dis. |volume=176 Suppl 2 |issue= |pages=S92–8 |date=December 1997 |pmid=9396689 |doi= |url=}}</ref>
**** [[gastroenteritis]]
*** [[Cytomegalovirus]]:<ref name="pmid10406985">{{cite journal |vauthors=Kuwabara S, Ogawara K, Koga M, Mori M, Hattori T, Yuki N |title=Hyperreflexia in Guillain-Barré syndrome: relation with acute motor axonal neuropathy and anti-GM1 antibody |journal=J. Neurol. Neurosurg. Psychiatry |volume=67 |issue=2 |pages=180–4 |date=August 1999 |pmid=10406985 |pmc=1736477 |doi= |url=}}</ref>
**** Respiratory infection, [[mononucleosis]] and flu-like symptoms.
*** [[Haemophilus influenzae]]<ref name="pmid10214761">{{cite journal |vauthors=Mori M, Kuwabara S, Miyake M, Dezawa M, Adachi-Usami E, Kuroki H, Noda M, Hattori T |title=Haemophilus influenzae has a GM1 ganglioside-like structure and elicits Guillain-Barré syndrome |journal=Neurology |volume=52 |issue=6 |pages=1282–4 |date=April 1999 |pmid=10214761 |doi= |url=}}</ref>
*** [[Epstein Barr virus|Epstein-Barr virus]]
**** [[Mononucleosis]]
*** [[Varicella zoster virus]]<ref name="pmid3404161">{{cite journal |vauthors=Winer JB, Hughes RA, Anderson MJ, Jones DM, Kangro H, Watkins RP |title=A prospective study of acute idiopathic neuropathy. II. Antecedent events |journal=J. Neurol. Neurosurg. Psychiatry |volume=51 |issue=5 |pages=613–8 |date=May 1988 |pmid=3404161 |pmc=1033063 |doi= |url=}}</ref>
**** [[Chicken pox]]
*** [[HIV]]-1<ref name="pmid3674806">{{cite journal |vauthors=Berger JR, Difini JA, Swerdloff MA, Ayyar DR |title=HIV seropositivity in Guillain-Barré syndrome |journal=Ann. Neurol. |volume=22 |issue=3 |pages=393–4 |date=September 1987 |pmid=3674806 |doi=10.1002/ana.410220320 |url=}}</ref>
** Recent vaccination:<ref name="pmid2450302">{{cite journal |vauthors=Hemachudha T, Griffin DE, Chen WW, Johnson RT |title=Immunologic studies of rabies vaccination-induced Guillain-Barré syndrome |journal=Neurology |volume=38 |issue=3 |pages=375–8 |date=March 1988 |pmid=2450302 |doi= |url=}}</ref><ref name="pmid1851395">{{cite journal |vauthors=Safranek TJ, Lawrence DN, Kurland LT, Culver DH, Wiederholt WC, Hayner NS, Osterholm MT, O'Brien P, Hughes JM |title=Reassessment of the association between Guillain-Barré syndrome and receipt of swine influenza vaccine in 1976-1977: results of a two-state study. Expert Neurology Group |journal=Am. J. Epidemiol. |volume=133 |issue=9 |pages=940–51 |date=May 1991 |pmid=1851395 |doi= |url=}}</ref>
*** [[Influenza vaccine]]
*** [[Rabies vaccine]]
** Limb tingling and [[paresthesia]]
** Lower extremity weakness<ref name=":0" />
** muscle pain<ref name="pmid9040715" />
***


====Autonomic====
=== Common symptoms ===
* Dizziness on standing from sitting or lying position (orthostatic hypotension)
Common symptoms of Guillain Barre syndrome include:
* Awareness of self heartbeat ([[Palpitations]])
* Most of Guillain Barre syndrome cases can be diagnosed based on partially symmetrical ascending weakness and [[paralysis]].
* Increased or no sweating.
* Can cause sensory [[Symptom|symptoms]] such as tingling and [[paresthesia]].<ref name=":0">{{cite book | last = Mattle | first = Heinrich | title = Fundamentals of neurology : an illustrated guide | publisher = Thieme | location = Stuttgart New York | year = 2017 | isbn = 9783131364524 }}</ref>
* Difficulty or urinary retention.
* Because of nerve inflammation, in the acute phase of GBS patients complain of pain.<ref name="pmid9040715">{{cite journal |vauthors=Moulin DE, Hagen N, Feasby TE, Amireh R, Hahn A |title=Pain in Guillain-Barré syndrome |journal=Neurology |volume=48 |issue=2 |pages=328–31 |date=February 1997 |pmid=9040715 |doi= |url=}}</ref>
* [[Constipation]] secondary to bowel paralysis.
* Some of the features may be specific to different subgroups of GBS.
** Acute inflammatory [[demyelinating]] polyneuropathy:<ref>{{Victor, M., 2001. Diseases of spinal cord peripheral nerve and muscle. Principles of Neurology}}</ref>(4)
*** It affects lower extremities first and then involves upper extremities, trunk, neck and [[cranial nerves]].
*** It can involve sensory neurons.
*** Deep sensation is the most affected sense.
*** It causes [[areflexia]]
*** In AIDP we may see [[Autonomic dysfunction|autonomic involvement]] such as changes in [[heart rate]] and [[blood pressure]] and [[urinary retention]].
** [[Acute motor axonal neuropathy]]/Acute motor and sensory axonal neuropathy:<ref name="pmid">{{cite journal |vauthors=Kuwabara S, Ogawara K, Koga M, Mori M, Hattori T, Yuki N |title=Hyperreflexia in Guillain-Barré syndrome: relation with acute motor axonal neuropathy and anti-GM1 antibody |journal=J. Neurol. Neurosurg. Psychiatry |volume=67 |issue=2 |pages=180–4 |date=August 1999 |pmid= |pmc=1736477 |doi= |url=}}</ref><ref name="pmid12084449">{{cite journal |vauthors=Kuwabara S, Nakata M, Sung JY, Mori M, Kato N, Hattori T, Koga M, Yuki N |title=Hyperreflexia in axonal Guillain-Barré syndrome subsequent to Campylobacter jejuni enteritis |journal=J. Neurol. Sci. |volume=199 |issue=1-2 |pages=89–92 |date=July 2002 |pmid=12084449 |doi= |url=}}</ref>
*** Can causes [[hyperreflexia]].
*** [[Autonomic dysfunction]] in absent or mild.
*** AMSAN can causes severe type of GBS with slow recovery
** [[Miller Fisher syndrome]]<ref name="pmid11320188">{{cite journal |vauthors=Mori M, Kuwabara S, Fukutake T, Yuki N, Hattori T |title=Clinical features and prognosis of Miller Fisher syndrome |journal=Neurology |volume=56 |issue=8 |pages=1104–6 |date=April 2001 |pmid=11320188 |doi= |url=}}</ref>
*** This type of GBS causes [[ophthalmoplegia]].
*** The reflexes are absence.
*** There is gait abnormalities ([[Ataxia]]).


====Cranial nerve====
=== Less Common Symptoms ===
* Usually symptoms due to involvement of cranial nerves follows weakness of limbs and trunk. However, in the [[Miller-Fisher variant]] of GBS cranial nerve are the first to get involved followed by limb involvement <ref name="pmid17657801">{{cite journal |author=Lo YL |title=Clinical and immunological spectrum of the Miller Fisher syndrome |journal=[[Muscle & Nerve]] |volume=36 |issue=5 |pages=615–27 |year=2007 |month=November |pmid=17657801 |doi=10.1002/mus.20835 |url=http://dx.doi.org/10.1002/mus.20835 |accessdate=2012-02-23}}</ref>.
Less common symptoms of Guillain Barre syndrome include:
* [[Blurred vision]], [[double vision]]
* Symptoms of [[papilledema]] such as
* Eye movement abnormalities are not commonly seen in ascending GBS, but are a prominent feature in the Miller-Fisher variant
** [[Headache]]
* Difficulty in swallowing speaking and drooling of saliva.
** [[Visual disturbance]]<ref name="pmid13493684">{{cite journal |vauthors=JOYNT RJ |title=Mechanism of production of papilledema in the Guillain-Barre syndrome |journal=Neurology |volume=8 |issue=1 |pages=8–12 |date=January 1958 |pmid=13493684 |doi= |url=}}</ref>
* Facial weakness may also be seen.
* Involuntary facial movement ([[facial myokymia]])<ref name="pmid6681885">{{cite journal |vauthors=Mateer JE, Gutmann L, McComas CF |title=Myokymia in Guillain-Barré syndrome |journal=Neurology |volume=33 |issue=3 |pages=374–6 |date=March 1983 |pmid=6681885 |doi= |url=}}</ref>
* Uncoordinated movements presenting as clumsiness in walking and history of fall may be seen.
* Hearing loss<ref name="pmid3399076">{{cite journal |vauthors=Nelson KR, Gilmore RL, Massey A |title=Acoustic nerve conduction abnormalities in Guillain-Barré syndrome |journal=Neurology |volume=38 |issue=8 |pages=1263–6 |date=August 1988 |pmid=3399076 |doi= |url=}}</ref>
 
* Difficulty speaking (vocal cord paralysis)<ref name="pmid8441543">{{cite journal |vauthors=Panosian MS, Quatela VC |title=Guillain-Barré syndrome presenting as acute bilateral vocal cord paralysis |journal=Otolaryngol Head Neck Surg |volume=108 |issue=2 |pages=171–3 |date=February 1993 |pmid=8441543 |doi=10.1177/019459989310800211 |url=}}</ref>
===Emergency symptoms (seek immediate medical help)===
* Mental status changes<ref name="pmid16000335">{{cite journal |vauthors=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 |title=Vivid dreams, hallucinations, psychosis and REM sleep in Guillain-Barré syndrome |journal=Brain |volume=128 |issue=Pt 11 |pages=2535–45 |date=November 2005 |pmid=16000335 |doi=10.1093/brain/awh585 |url=}}</ref>
*[[Difficulty breathing]]
*[[Difficulty swallowing]]
*[[Drooling]]
*[[Fainting]]
*Feeling [[light-headed]] when standing


==References==
==References==
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Latest revision as of 16:59, 27 December 2018

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

Overview

Patients with Guillain Barre syndrome may have a positive history of: Prior infection with Campylobacter jejuni, Cytomegalovirus, Haemophilus influenzae, Epstein-Barr virus, Varicella zoster virus and HIV-1, recent vaccination with influenzae or rabies vaccine, limb tingling and paresthesia, lower extremity weakness and muscle pain.

Common symptoms of Guillain Barre syndrome include: Symmetrical ascending weakness and paralysis, tingling and paresthesia and pain.

History and Symptoms

History

Common symptoms

Common symptoms of Guillain Barre syndrome include:

Less Common Symptoms

Less common symptoms of Guillain Barre syndrome include:

References

  1. ↑ Hughes RA, Rees JH (December 1997). "Clinical and epidemiologic features of Guillain-Barré syndrome". J. Infect. Dis. 176 Suppl 2: S92–8. PMID 9396689.
  2. ↑ 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. PMID 10406985.
  3. ↑ Mori M, Kuwabara S, Miyake M, Dezawa M, Adachi-Usami E, Kuroki H, Noda M, Hattori T (April 1999). "Haemophilus influenzae has a GM1 ganglioside-like structure and elicits Guillain-Barré syndrome". Neurology. 52 (6): 1282–4. PMID 10214761.
  4. ↑ 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.
  5. ↑ Berger JR, Difini JA, Swerdloff MA, Ayyar DR (September 1987). "HIV seropositivity in Guillain-Barré syndrome". Ann. Neurol. 22 (3): 393–4. doi:10.1002/ana.410220320. PMID 3674806.
  6. ↑ Hemachudha T, Griffin DE, Chen WW, Johnson RT (March 1988). "Immunologic studies of rabies vaccination-induced Guillain-Barré syndrome". Neurology. 38 (3): 375–8. PMID 2450302.
  7. ↑ Safranek TJ, Lawrence DN, Kurland LT, Culver DH, Wiederholt WC, Hayner NS, Osterholm MT, O'Brien P, Hughes JM (May 1991). "Reassessment of the association between Guillain-Barré syndrome and receipt of swine influenza vaccine in 1976-1977: results of a two-state study. Expert Neurology Group". Am. J. Epidemiol. 133 (9): 940–51. PMID 1851395.
  8. ↑ 8.0 8.1 Mattle, Heinrich (2017). Fundamentals of neurology : an illustrated guide. Stuttgart New York: Thieme. ISBN 9783131364524.
  9. ↑ 9.0 9.1 Moulin DE, Hagen N, Feasby TE, Amireh R, Hahn A (February 1997). "Pain in Guillain-Barré syndrome". Neurology. 48 (2): 328–31. PMID 9040715.
  10. ↑ Template:Victor, M., 2001. Diseases of spinal cord peripheral nerve and muscle. Principles of Neurology
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ JOYNT RJ (January 1958). "Mechanism of production of papilledema in the Guillain-Barre syndrome". Neurology. 8 (1): 8–12. PMID 13493684.
  15. ↑ Mateer JE, Gutmann L, McComas CF (March 1983). "Myokymia in Guillain-Barré syndrome". Neurology. 33 (3): 374–6. PMID 6681885.
  16. ↑ Nelson KR, Gilmore RL, Massey A (August 1988). "Acoustic nerve conduction abnormalities in Guillain-Barré syndrome". Neurology. 38 (8): 1263–6. PMID 3399076.
  17. ↑ 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.
  18. ↑ 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.

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