Guillain-Barre syndrome GBS)

Pathogenesis:

• A demyelinating neuropathy
• Has an autoallergic basis
• Follows 1-3 weeks after infection (that is often trivial and rarely identified)
• Campylobacter infection, however, is a recognised cause of GBS

Clinical features:

• Weakness of distal limb muscles and/or distal numbness ascending over several days or over a period of up to 3 weeks
• In mild cases, there is little disability before spontaneous recovery begins
• 20% of cases have complete paralysis, including respiratory muscles
• Weakness, areflexia and sensory loss are found in an ascending pattern from fingers to toes

Diagnosis:

• Established on clinical grounds
• Confirmed by nerve conduction studies, which show:
• slowing of conduction
• prolonged distal motor latency

• Raised CSF protein level

Course and management:

• It is essential (even in the early stages) that particular attention be paid to measuring ventilatory function (VC and blood gases)
• Prolonged assisted ventilation may be necessary
• Subcutaneous heparin should be given to reduce the risk of venous thrombosis
• High doses of γ-globulin reduces the severity and duration and should be given to all patients
• Recovery, though gradual over many months, is usual but may be incomplete