Guillain-Barre Syndrome

Key considerations: Respiratory failure requiring intubation, Autonomic dysfunction, Spinal cord compression mimicking GBS

Cannot miss

history: Ascending weakness, paresthesias, antecedent GI or respiratory illness (1-4 weeks prior); Campylobacter jejuni infection is most common trigger; exam: Symmetric ascending weakness, areflexia/hyporeflexia, sensory exam, respiratory effort; labs: LP: albuminocytologic dissociation (elevated protein, normal WBC); May be normal in first week; imaging: MRI spine to rule out structural lesion if atypical presentation; bedside: Serial FVC and NIF measurements (intubate if FVC <20mL/kg or NIF < -30); Nerve conduction studies/EMG

immediate: ICU admission for monitoring; Serial respiratory function (FVC q4-6hr); general: IVIG 0.4g/kg/day x5 days OR plasmapheresis x5 sessions — equally effective; Do NOT give both IVIG and PLEX; Steroids are NOT effective in GBS; VTE prophylaxis, pain management, PT/OT

admit: All GBS patients — ICU if any respiratory, bulbar, or autonomic concerns; discharge: After stabilization/improvement with rehab plan; consults: Neurology, pulmonology/ICU if respiratory involvement

20-30% of GBS patients will require mechanical ventilation — monitor FVC serially
The "20/30/40 rule" for intubation: FVC <20mL/kg, NIF < -30cmH2O, or >30% decline in FVC
Miller Fisher variant: ataxia, areflexia, ophthalmoplegia — anti-GQ1b antibodies