Guillain-Barré syndrome(GBS)

Guillain-Barré syndrome

Written by – Dr Andrew Lam

Typical Precipitants of GBS

Up to two-thirds of patients report a preceding gastrointestinal or respiratory tract infection. These can include: 

• Campylobacter jejuni Gastroenteritis (Most common)
• CMV
• Influenza A and B
• COVID-19
• HIV

Variants of GBS

Acute inflammatory demyelinating polyneuropathy (AIDP) – symmetric progressive weakness with hyporeflexia

Acute motor axonal neuropathy (AMAN) – axonal variant with selective involvement of motor nerves without sensory symptoms which can occur with AIDP

Acute motor sensory axonal neuropathy (AMSAN) – more severe variant of AMAN with sensory involvement and may have delayed or incomplete recovery

Miller Fischer Syndrome (MFS) – typically presents with the triad of ophthalmoplegia, ataxia and areflexia, with some having concurrent limb weakness

Bickerstaff Brainstem Encephalitis (BBE) – closely related to Miller Fischer, but presents with encephalopathy, ophthalmoplegia and ataxia

Investigations for GBS

Lumbar Puncture – Typically shows albuminocytologic dissociation (elevated protein but normal WCC)

Nerve Conduction Studies and EMG – May assist in diagnosis, prognostication and determination of severity of disease

MRI Spine and Brain – Can be considered in patients presenting with atypical symptoms, or with quadriplegia or bulbar symptoms