Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- muscle weakness
- paraesthesia
- back/leg pain
- respiratory distress
- speech problems
- areflexia/hyporeflexia
- facial weakness
- bulbar dysfunction causing oropharyngeal weakness
- extra-ocular muscle weakness
- facial droop
- diplopia
- dysarthria
- dysphagia
- dysautonomia
- pupillary dysfunction
- ophthalmoplegia
Risk factors
- preceding viral illness
- preceding bacterial infection
- preceding mosquito-borne viral infection
- hepatitis E infection
- immunisation
- cancer and lymphoma
- older age
- HIV infection
- COVID-19 infection
- male
Diagnostic investigations
Investigations to consider
- anti-ganglioside antibody
- serology
- stool culture
- HIV antibodies
- spinal MRI
- Borrelia burgdorferi serology
- cerebrospinal fluid (CSF) meningococcal polymerase chain reaction
- CSF cytology
- CSF angiotensin-converting enzyme
- chest x-ray
- CSF VDRL
- CSF West Nile polymerase chain reaction
Treatment algorithm
Contributors
Authors
Saiju Jacob, MD, DPhil, MRCP (UK), FRCP (Lon)
Consultant Neurologist
Queen Elizabeth Neurosciences Centre
University Hospital Birmingham
Birmingham
UK
Disclosures
SJ has served as an international advisory board member for Alexion, Alnylam, ArgenX, Regeneron, Immunovant, and UCB pharmaceuticals. He is currently an expert panel member of the Myasthenia Gravis consortium for ArgenX, and has received speaker fees from Terumo BCT and Eisai.
Acknowledgements
Dr Saiju Jacob would like to gratefully acknowledge Dr John B. Winer, Dr Michael T. Torbey, Dr Dhruvil J. Pandya, and Dr Prem A. Kandiah, previous contributors to this topic.
Disclosures
JBW, MTT, DJP, and PAK declare that they have no competing interests.
Peer reviewers
Cigdem Akman, MD
Division of Pediatric Neurology
Columbia University College of Physicians and Surgeons
New York
NY
Disclosures
CA declares that he has no competing interests.
Robert Hadden, FRCP, PhD
Consultant Neurologist
King's College Hospital
London
UK
Disclosures
RH has been paid by Baxter Healthcare Ltd for membership of its neurology advisory board, and is a co-author of several studies referenced in this topic.
References
Key articles
Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet. 2016 Aug 13;388(10045):717-27.Full text Abstract
Stowe J, Andrews N, Wise L, et al. Investigation of the temporal association of Guillain-Barré syndrome with influenza vaccine and influenzalike illness using the United Kingdom General Practice Research Database. Am J Epidemiol. 2009 Feb 1;169(3):382-8.Full text Abstract
Hughes RA, Swan AV, van Doorn PA. Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2014 Sep 19;(9):CD002063.Full text Abstract
Lawn ND, Fletcher DD, Henderson RD, et al. Anticipating mechanical ventilation in Guillain-Barré syndrome. Arch Neurol. 2001 Jun;58(6):893-8.Full text Abstract
Hughes RA, Brassington R, Gunn AA, et al. Corticosteroids for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2016 Oct 24;(10):CD001446.Full text Abstract
Walgaard C, Jacobs BC, Lingsma HF, et al. Second intravenous immunoglobulin dose in patients with Guillain-Barré syndrome with poor prognosis (SID-GBS): a double-blind, randomised, placebo-controlled trial. Lancet Neurol. 2021 Apr;20(4):275-83. Abstract
Reference articles
A full list of sources referenced in this topic is available here.
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