Describe the diagnosis and management of Guillain–Barré syndrome.

Guillain–Barré Syndrome (Landry–Guillain–Barré syndrome) is one of the most common neurological disorders which requires intensive care. Anaesthetists need to be familiar not only with the ITU management of a complex disorder, but also with the clinical features which make ITU admission and IPPV more likely.

Introduction

Guillain–Barré syndrome is an acute demyelinating polyneuropathy of uncertain aetiology. It is believed to have an immunological basis as it frequently follows viral and other infections. Its presentation is variable, although motor weakness is more pronounced than sensory loss.

History

• Recent viraemia or bacterial infection, e.g. campylobacter, also immunisations and surgery.

• Ascending motor weakness is typical, onset over days (can be rapid).

• Sensory symptoms and paraesthesia, also pain in >50% and hyperpathia.

• Differential diagnosis: other causes of acute polyneuropathy/polyneuritis: poisons, drugs, organophosphates, heavy metals, alcohol, malignancy, inflammatory processes, transverse myelitis, poliomyelitis, Lyme disease, AIDS, myasthenia gravis.

Examination

• Motor impairment, loss of deep tendon reflexes, sensory changes.

• Signs of autonomic instability: postural hypotension, sweating, tachycardia, hypertension.

Investigations

• Lumbar puncture: increase in CSF proteins, white count unchanged.

• Serology: may have antibodies, e.g. to Ebstein–Barr virus, mycoplasma, campylobacter.

• Nerve conduction: reduced at various sites.