Guillain-Barre syndrome: features

Guillain-Barre syndrome describes an immune-mediated demyelination of the peripheral nervous system often triggered by an infection (classically Campylobacter jejuni)

Initial symptoms

• around 65% of patients experience back/leg pain in the initial stages of the illness

The characteristic features of Guillain-Barre syndrome is progressive, symmetrical weakness of all the limbs.

• the weakness is classically ascending i.e. the legs are affected first
• reflexes are reduced or absent
• sensory symptoms tend to be mild (e.g. distal paraesthesia) with very few sensory signs

Other features

• there may be a history of gastroenteritis
• respiratory muscle weakness
• cranial nerve involvement
  • diplopia
  • bilateral facial nerve palsy
  • oropharyngeal weakness is common
• autonomic involvement
  • urinary retention
  • diarrhoea

Less common findings

• papilloedema: thought to be secondary to reduced CSF resorption

Investigations

• lumbar puncture
  • rise in protein with a normal white blood cell count (albuminocytologic dissociation) - found in 66%
• nerve condution studies may be performed
  • decreased motor nerve conduction velocity (due to demyelination)
  • prolonged distal motor latency
  • increased F wave latency