Guillain-Barré syndrome (GBS) is a rare and potentially catastrophic paralyzing disorder of the peripheral nerves.¹ It is also known as Landry’s ascending paralysis, postinfectious polyneuropathy, and acute inflammatory demyelinating polyneuropathy. The emergency physician is often the first to see GBS patients as the illness evolves. Early diagnosis, or at least suspicion of GBS, is important to provide a better outcome as delayed treatment can lead to unrecognized failing respiration and life-threatening dysrhythmias.^2–4 Given that GBS is rare, presents with the common chief complaint of weakness, and has no simple diagnostic lab test for its confirmation, it is an easy diagnosis to miss.

Clinical Features

Here’s a list of clinical features to raise suspicion of GBS when a patient presents to the emergency department:⁵

• Relatively new onset of weakness, within a day to three to four weeks.
• Symmetrical weakness rather than unilateral.
• Most typically, an ascending pattern of weakness (eg, a waddling gait; difficulty climbing stairs; difficulty rising from the bed, chair, or floor).
• New pain of the thighs and/or low back; pain can be an early—and even the first—symptom of GBS.
• Early dysesthesias (eg, numbness, tingling, and formications of the feet, hands, and distal limbs—even the face or gums).
• Absent or diminished deep-tendon reflexes, a hallmark of GBS.
• Elevated spinal fluid protein without elevated cerebrospinal fluid cells, another hallmark of GBS.
• Recent viral or other infection (eg, upper respiratory infection, sore throat, diarrhea), seen in two-thirds of GBS patients.

People of any age can develop GBS, from babies to seniors. If you are unsure what’s going on, it may be safer to admit the patient and get a neurology consult. A confirmatory nerve conduction study/electromyography study will likely be planned. Urgent diagnosis is important since early treatment with high-dose intravenous immunoglobulins or plasma exchange can often shorten the disease’s course if started within two weeks of onset of symptoms. Corticosteroids have not been found beneficial and may even lengthen its course.

References

1. Guillain GC, Barré JA, Strohl A. Sur un syndrome de radiculonevrite avec hyperalbuminose du liquide céphalo-rachidien sans réaction cellulaire: remarques sur les caractères et graphiques des réflexes tendineux. Bulletins et mémoires de la Société des Médecins des Hôpitaux de Paris. 1916;40:1462-1470.
2. Hughes RA, Wijdicks EF, Benson E, et al. Supportive care for patients with Guillain-Barré syndrome. Arch Neurol. 2005;62(8):1194-1198.
3. Yuki N, Hartung HP. Guillain-Barré syndrome. N Engl J Med. 2012;366:2294-2304.
4. Greenland P, Griggs RC. Arrhythmic complications in the Guillain-Barré syndrome. Arch Intern Med. 1980;140(8):1053-1055.
5. Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol. 1990;27:Supple:S21-S24.

Dr. Steinberg is a hospitalist for Cooper University Hospital in Camden, New Jersey. As he was recovering from GBS, he helped found the GBS/CIDP (Chronic Inflammatory Demyelinating Polyneuropathy) Foundation International.