GUILLAIN-BARRE SYNDROME (GBS, aka ACUTE INFLAMMATORY DEMYELINATING POLYNEUROPATHY or AIDP)

Patients suffering from Guillain-Barre syndrome (GBS, aka acute inflammatory demyelinating polyneuropathy or AIDP) may initially complain of back pain, fever and can have a facial palsy and proximal muscle weakness (trouble rising from chair or shrugging shoulders) prior to lower extremity symptoms. Classically, though, it is an ascending paralysis over several days to weeks in which there is ataxia and then an inability to walk. Look for diminished or absent reflexes in the lower extremities on exam. Sensation is preserved (as is bowel and bladder continence). It can progress to respiratory compromise requiring intubation. Perform a lumbar puncture to look for albuminocytologic dissociation (increased CSF protein in the absence increased WBCs). FYI… they could say there is an absence of pleocytosis (pleocytosis means an increase in WBC’s). For treatment, you can try IVIG or plasmapheresis.

PEARLS:  Steroids DO NOT help. Pulse oximetry is a poor indicator of neuromuscular respiratory insufficiency. You can, however, try to obtain a negative inspiratory flow (NIF) or a Forced Vital Capacity (FVC) if the child is old enough to participate with the test (at least 5 years of age). Always keep tick paralysis in your differential, especially if they mention the summer time, a recent vacation, or the woods! Additionally, if someone presents with GBS a few weeks after a diarrheal illness, they might be referring to C. jejuni infection (known antecedent to GBS though mechanism is not understood). Also, when compared to any CORD COMPRESSION SYNDROME, GBS maintains rectal tone, bowel/bladder continence and sensation. It also has decreased reflexes. In cord compression syndromes, sensation, tone and continence are lost, and reflexes are increased.