Guillain-Barre

Alternative names:

acute idiopathic polyneuritis; acute inflammatory polyneuropathy; infectious polyneuritis; Landry-Guillain-Barre syndrome

Symptoms:

The disorder progresses rapidly (from days to about 1 month). Weakness and paralysis usually develop in a symmetrical manner from the feet and legs upward through the body, and is referred to as ascending paralysis. As paralysis reaches the level of the chest, the patient may require assisted ventilation in order to breathe. Movement and sensation changes occur simultaneously.

There is an initial phase of rapid symptom development that usually lasts for up to 3 weeks. This is followed by a plateau phase of no changes, then a recovery phase where symptoms improve. The recovery phase may last 4 to 6 months or longer.

Typical symptoms include:

• muscle weakness or paralysis (the most common symptom) or uncoordinated movements
  • weakness begins in the feet and legs and may progress upward to the arms and cranial (head) nerves
  • may progress rapidly over 24 to 72 hours
  • may begin in the arms and progress downward
  • may occur in the arms and legs at the same time
  • may occur in the cranial nerves only
  • may not occur (mild cases)

• sensation changes
  • numbness, decreased sensation
  • tenderness or muscle pain (may be a cramp-like pain)
  • usually accompanies or precedes muscle weakness
  • may not occur at all

Additional symptoms that may be associated with this disease:

• blurred vision
• difficulty moving face muscles
• dizziness
• palpitations (sensation of feeling heartbeat)
• difficulty beginning to urinate
• feeling of incomplete bladder emptying
• incontinence (leaking) of urine
• constipation
• muscle contractions

Symptoms indicating an emergency:

• difficulty swallowing, drooling
• difficulty breathing
• breathing absent temporarily
• feeling "unable to take a deep breath"
• fainting

Signs and tests:

A history of illness involving fever, followed by increasing muscle weakness and paralysis, may indicate Guillain-Barre syndrome.

Neuromuscular examination shows muscular (motor) dysfunction and may indicate dysfunction of the control of involuntary (autonomic) body functions. There is usually minimal sensory loss, even when there are sensory changes present. There may be evidence of decreased breathing ability caused by paralysis of the breathing muscles and a decrease in deep tendon reflexes in the arms and legs. Autonomic dysfunction may include changes in blood pressure (high, low, or fluctuating blood pressure), changes in heart rate (fast or slow), urinary retention (bladder unable to constrict to empty itself), and other abnormalities.

• An NCV (nerve conduction velocity) shows demyelination.
• An EMG (a test of electrical activity in muscles) shows lack of nervous stimulation.
• A CSF (cerebrospinal fluid) examination may be abnormal, showing increase in protein without increase in white blood cell count.
• An ECG may show abnormalities in some cases.