Guillain–Barré syndrome

94 Guillain–Barré syndrome



Instruction


Examine this patient’s lower limbs, whose weakness began distally.



Salient features



History




• Weakness: difficulty in rising up from standing position or climbing stairs, legs usually affected before upper limbs


• Dyspnoea: late in the course suggesting diaphragmatic and intercostals muscle weakness


• Cranial nerve involvement: diplopia, drooling of saliva, regurgitation of food


• Paraesthesias


• Urinary symptoms


• Systemic symptoms: fatigue


• Ascertain whether the onset was preceded by a trivial viral illness.



Examination




• Weakness of distal limb muscles


• Distal numbness


• Areflexia.


Proceed as follows:



• Tell the examiner that you would like to:


• assess respiratory function (forced vital capacity)

• check BP (for labile BP).

Remember: Polyneuropathies can be classified as demyelinating or axonal. They can also be classified according to the diameter of the affected nerve fibre. Larger fibres are heavily myelinated and, therefore, most subject to processes that damage myelin. Most polyneuropathies, including the diabetic type, are axonal.



Diagnosis


This patient has Guillain–Barré syndrome (lesion) and is currently experiencing weakness of the distal limb muscles (functional status).



Questions




What features are required for diagnosis?




• Progressive weakness in both arms and legs (might start with weakness only in the legs)


• Areflexia (or decreased tendon reflexes).



What features strongly support diagnosis?




• Progression of symptoms over days to 4 weeks


• Relative symmetry of symptoms


• Mild sensory symptoms or signs


• Cranial nerve involvement, especially bilateral weakness of facial muscles


• Autonomic dysfunction


• Pain (often present)


• High concentration of protein in CSF


• Typical electrodiagnostic features.

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Guillain–Barré syndrome

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