Typical presentation of GBS

What is the typical presentation of GBS? 

The most common motor neuropathy is Guillain Barre syndrome.

Symptoms often begin 1 to 3 weeks after a viral upper respiratory or gastrointestinal infection, immunization, or surgery.

A typical patient with GBS reports a numb or tingling sensation in the arms and legs, followed by rapidly progressive ascending symmetric muscle weakness sometimes to the point of flaccid quadriplegia and inability to speak or swallow.

Up to 30% of patients require artificial respiration.

Paralysis is maximal by 2 weeks in more than 50% of patients and by 4 weeks in more than 90%.

The patient may have mild impairment of distal sensation, but significant sensory loss is not seen.

Hyporeflexia or areflexia is invariably present. Preservation of reflexes in a severely weakened patient should seriously challenge the diagnosis of GBS. Pain is present in 50% of patients.

Over 50% of patients develop facial weakness, and 5% have extraocular muscular paralysis. Many patients also have autonomic dysfunction, including tachycardia, dysrhythmias, and very labile blood pressures.

There are several symptomatic variants of GBS that probably form a continuous spectrum of disease including

  • Miller–Fisher syndrome (the triad of ataxia, areflexia, and ophthalmoplegia often associated with GQ1b antibodies),
  • Bickerstaff brainstem encephalitis, and
  • the pharyngeal–cervical–brachial variant of GBS. 

Sources

  • Arcila-Londono X, Lewis RA: Guillain-Barré syndrome. Semin Neurol 32(3):179-186. 2012. 
  • Dimachkie MM, Barohn RJ: Guillain-Barré syndrome and variants. Neurol Clin 31(2):491–510, 2013.
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