Guillain-Barré syndromeMANAGEMENT

NEUROLOGICAL PRESENTATIONS · 12 SECTIONS

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596 items

☷ Legend

01Approach to the Critical Patient/attcp66

Immediate stabilization

›Time-critical threats

›Respiratory failure

›Rapidly progressive weakness within hours to days

›Bulbar dysfunction

›Weak cough or inability to clear secretions

›Single breath count < 15

›Autonomic instability

›Bradyarrhythmia

›Tachyarrhythmia

›Labile blood pressure

›Urinary retention

›Mimic requiring immediate reversal

›Myasthenic crisis

›Botulism

›Spinal cord compression

›Airway and ventilation triggers

›Bedside respiratory metrics

›Forced vital capacity < 20 mL/kg

›Negative inspiratory force weaker than -30 cm H2O

›Peak cough flow low or absent

›If any trigger present, escalate for airway control

›Early critical care consultation

›Avoid delay for imaging or lumbar puncture

›Monitoring and access

›Continuous telemetry

›Ventricular ectopy

›Sinus pauses

›Noninvasive blood pressure frequent cycling

›If labile, arterial line

›Two large bore IV lines

›If IVIg planned, infusion capable access

›Early specialist activation

›Neurology

›Electrophysiology planning

›Immunotherapy selection

›Critical care

›Ventilator planning

›Dysautonomia management

Key decision points

›Disease pattern confirmation

›Progressive bilateral limb weakness

›Symmetric more than asymmetric

›Distal and proximal possible

›Hyporeflexia or areflexia

›Early preserved reflexes possible

›Time course

›Onset to nadir within 4 weeks

›Immediate exclusions

›If sensory level or sphincter early, spinal cord process

›Urgent MRI spine

›If fluctuating fatigable weakness, neuromuscular junction process

›Bedside ice test if ptosis

›Consider acetylcholine receptor testing later

›Severity triage

›ICU risk features

›Rapid progression

›Bulbar weakness

›Dysautonomia

›FVC < 20 mL/kg

Pitfalls

›Early normal cerebrospinal fluid

›Albuminocytologic dissociation may be absent in first week

›Early normal nerve conduction study

›Repeat study may be needed after 1 to 2 weeks

›Steroids as monotherapy

›No proven benefit in typical GBS

›Succinylcholine use in paralysis

›Hyperkalemia risk

02History/hx53

Presenting features and timing

›Symptom pattern

›Ascending weakness

›Legs before arms common

›Difficulty climbing stairs

›Facial weakness

›Bilateral facial palsy

›Sensory symptoms

›Distal paresthesias

›Neuropathic pain

›Autonomic symptoms

›Palpitations

›Presyncope

›Sweating abnormalities

›Time course

›Onset date

›Hours to days progression typical

›Time to nadir

›Less than 4 weeks supports GBS

›Functional trajectory

›Ambulation status

›Independent

›Assisted

›Unable

›Swallowing and speech

›Choking

›Dysarthria

›Breathing symptoms

›Dyspnea at rest

›Orthopnea

›Weak cough

Triggers and risk factors

›Antecedent infection

›Gastroenteritis

›Campylobacter exposure

›Upper respiratory infection

›Influenza like illness

›Recent COVID-19 infection

›Date of onset

›Recent vaccination

›Vaccine type

›Date administered

›Travel and vector exposure

›Mosquito exposure

›Zika risk region

›Immune status and comorbidities

›HIV risk or known HIV

›Recent seroconversion symptoms

›Malignancy

›Immune checkpoint inhibitors exposure

›Alternative toxin and drug exposures

›Botulinum exposure risks

›Home canned foods

›Tick exposure

›Tick paralysis risk

03Physical Exam/exam50

Neurologic examination

›Motor pattern

›Symmetric weakness distribution

›Proximal involvement

›Distal involvement

›Neck flexion weakness

›Predictor of respiratory compromise

›Reflexes

›Deep tendon reflexes

›Areflexia

›Hyporeflexia

›Preserved reflexes

›AMAN variant possibility

›Sensory findings

›Light touch

›Mild distal loss typical

›Proprioception

›Ataxia support for sensory involvement

›Cranial nerves

›Facial weakness

›Bilateral lower motor neuron pattern

›Extraocular movements

›Ophthalmoplegia suggests Miller Fisher spectrum

›Bulbar function

›Gag reflex

›Palatal elevation

›Tongue strength

›Coordination and gait

›Truncal ataxia

›Miller Fisher spectrum

›Gait safety

›High fall risk with proximal weakness

Respiratory and autonomic assessment

›Work of breathing

›Accessory muscle use

›Fatigue signs

›Paradoxical breathing

›Diaphragm weakness

›Bedside respiratory mechanics

›Forced vital capacity

›Trend over hours

›Negative inspiratory force

›Trend over hours

›Autonomic findings

›Heart rate variability

›Marked fluctuations

›Blood pressure lability

›Orthostatic drop

›Pupillary abnormalities

›Dysautonomia support

›Ileus and urinary retention

›Bladder scan volume

04Differential Diagnosis/ddx49

Life-threatening and treatable mimics

›Neuromuscular junction disorders

›Myasthenia gravis crisis

›Fluctuating fatigable weakness

›Ptosis and diplopia prominent

›Botulism

›Descending paralysis

›Prominent autonomic symptoms

›Dilated poorly reactive pupils

›Spinal cord and root disorders

›Spinal cord compression

›Sensory level

›Early bowel or bladder involvement

›Transverse myelitis

›Hyperreflexia possible

›Sensory level

›Cauda equina syndrome

›Saddle anesthesia

›Severe back pain

›Central nervous system disorders

›Brainstem stroke

›Asymmetric cranial nerve findings

›Abrupt onset

›Metabolic and toxic

›Hypokalemic paralysis

›Low serum potassium mmol/L

›Acute intermittent porphyria

›Abdominal pain

›Neuropsychiatric symptoms

›Tick paralysis

›Rapid improvement after tick removal

Related immune neuropathies and variants

›GBS spectrum disorders

›Acute inflammatory demyelinating polyradiculoneuropathy

›Most common in North America and Europe

›Acute motor axonal neuropathy

›Pure motor

›Acute motor sensory axonal neuropathy

›Severe sensory loss

›Miller Fisher syndrome

›Ophthalmoplegia

›Ataxia

›Areflexia

›Chronic inflammatory demyelinating polyradiculoneuropathy

›Progression beyond 8 weeks

›Relapsing course

Coding considerations

›ICD-10 and SNOMED CT

›ICD-10 G61.0 acute inflammatory demyelinating polyneuropathy

›Guillain-Barre syndrome

›SNOMED CT concept

›Guillain-Barre syndrome

05Laboratory Tests/lt47

Core laboratory evaluation

›Baseline safety and mimics

›Electrolytes

›Potassium mmol/L for paralysis mimic

›Sodium mmol/L for dysautonomia related hyponatremia

›Glucose mmol/L

›Hypoglycemia mimic

›Renal function

›IVIg dosing and safety

›Liver enzymes

›Differential support

›Complete blood count

›Infection clues

›Infection and trigger testing when indicated

›HIV antigen antibody

›New neuropathy

›Hepatitis serologies

›Risk factors present

›Campylobacter testing

›Recent diarrhea

›Inflammatory markers

›C-reactive protein

›Alternative inflammatory diagnoses

Cerebrospinal fluid studies

›Lumbar puncture profile

›Protein elevated with normal white blood cell count

›Albuminocytologic dissociation

›White blood cell count

›If > 50 cells per microliter, alternative diagnosis favored

›Glucose mmol/L

›Infection evaluation

›Timing limitations

›First week

›Protein may be normal

›After first week

›Protein elevation more common

Specialized and prognostic tests

›Autoantibodies when phenotype suggests

›Anti-GQ1b antibodies

›Miller Fisher spectrum support

›Anti-GM1 antibodies

›Axonal variants support

›Cardiac biomarkers

›Troponin

›If chest pain or arrhythmia concern

›Blood gas when ventilatory failure concern

›Arterial blood gas

›PaCO2 mmHg for hypoventilation

›Venous blood gas

›Trend support if ABG unavailable

06Diagnostic Tests/dt56

Scoring Systems

›Risk and severity scores

›EGRIS

›Uses time from onset to admission

›Uses facial or bulbar weakness

›Uses Medical Research Council sum score

›Higher score predicts mechanical ventilation risk

›mEGOS

›Uses age

›Uses preceding diarrhea

›Uses disability status at presentation

›Higher score predicts inability to walk at follow-up

›Hughes GBS disability scale

›0 healthy

›1 minor symptoms

›2 able to walk 10 m unassisted

›3 able to walk with assistance

›4 bedbound or chairbound

›5 ventilator dependent

›6 death

MRI

›Indications

›Alternative diagnosis exclusion

›Myelopathy

›Spinal cord compression

›Atypical features

›Sensory level

›Marked asymmetry

›Typical findings

›Nerve root enhancement

›Cauda equina roots

›Cranial nerve enhancement

›Facial nerve possible

›Limitations

›Normal MRI does not exclude GBS

›Diagnosis remains clinical with electrophysiology support

›Indications

›Acute stroke concern

›Abrupt onset focal deficits

›Intracranial process concern

›Altered mental status atypical for GBS

›Role in GBS

›Not diagnostic

›Primarily for mimic exclusion

›If back pain severe

›Consider CT for compressive lesion when MRI unavailable

Ultrasound

›Point of care applications

›Diaphragm ultrasound

›Reduced excursion supports impending respiratory failure

›Bladder ultrasound

›Urinary retention assessment

›Vascular ultrasound

›DVT evaluation

›Prolonged immobility

›Limitations

›Peripheral nerve ultrasound

›Emerging adjunct

›Not a standalone diagnostic test

07Disposition/dispo30

Level of care

›Admission criteria

›Suspected GBS

›Progression ongoing

›New inability to ambulate safely

›Need for immunotherapy

›IVIg or plasma exchange planned

›ICU criteria

›Respiratory compromise markers

›FVC < 20 mL/kg

›NIF weaker than -30 cm H2O

›Bulbar weakness

›Aspiration risk

›Autonomic instability

›Arrhythmias

›Labile blood pressure

›Rapid progression

›Loss of ambulation within 24 hours

›Transfer criteria

›No ICU capability

›Respiratory metrics declining

›No plasma exchange capability

›Severe disease with contraindication to IVIg

Follow-up and rehabilitation planning

›Inpatient rehabilitation planning

›Early physiatry involvement

›Mobility goals

›Physical therapy and occupational therapy

›Contracture prevention

›Outpatient neurology follow-up

›Mild cases after stabilization

›Scheduled within 1 to 2 weeks of discharge

08Treatment/t128

Immunotherapy

›Indications for disease modifying therapy

›Nonambulatory

›Hughes grade 4 or higher

›Rapidly progressive weakness

›Loss of ambulation

›Significant bulbar weakness

›Aspiration risk

›IVIg

›Dosing

›0.4 g/kg/day for 5 days

›Total 2 g/kg course

›Use actual body weight

›Alternative schedule

›1 g/kg/day for 2 days

›Consider only with specialist input

›Timing

›Best within 2 weeks of onset

›Evidence supports earlier initiation

›Monitoring

›Renal function

›Risk higher with sucrose containing preparations

›Thrombosis risk

›Hydration strategy

›Hemolysis risk

›Monitor hemoglobin if symptoms

›Adverse effects

›Aseptic meningitis

›Severe headache

›Infusion reaction

›Slow rate or premedication strategy

›Plasma exchange

›Dosing schedule

›4 exchanges over 7 to 14 days

›Typical 40 to 50 mL/kg per exchange

›Albumin replacement common

›Indications

›Severe weakness

›Nonambulatory

›IVIg contraindication

›IgA deficiency with anaphylaxis history

›Monitoring

›Calcium

›Citrate related hypocalcemia symptoms

›Hemodynamics

›Hypotension risk

›Line complications

›Infection risk

›Combination therapy considerations

›IVIg followed by plasma exchange

›Not routinely recommended

›Consider only with specialist input

›Steroids

›Systemic corticosteroids alone

›Not recommended in typical GBS

Respiratory support

›Serial respiratory mechanics

›Forced vital capacity

›Every 4 to 6 hours if unstable

›Negative inspiratory force

›Every 4 to 6 hours if unstable

›Noninvasive ventilation

›Limited role in bulbar dysfunction

›Aspiration risk

›Intubation strategy

›If respiratory triggers met, early intubation

›Avoid emergent crash intubation

›Neuromuscular blocker choice

›Avoid succinylcholine

›Hyperkalemia risk

›Nondepolarizing agent

›Prolonged effect possible

›Ventilator management

›Lung protective targets

›Adjust for neuromuscular weakness physiology

›Secretion management

›Chest physiotherapy

›Mechanical insufflation exsufflation if available

Autonomic and supportive care

›Dysautonomia management

›Bradycardia

›Atropine availability at bedside

›Transcutaneous pacing pads ready

›Hypertension

›Short acting agent preferred

›Labetalol IV titrated

›Avoid excessive hypotension

›Hypotension

›IV fluids cautious

›Avoid volume overload

›Vasopressor if persistent

›Norepinephrine infusion titration per ICU protocol

›Pain control

›Neuropathic pain

›Gabapentin

›Start low and titrate as tolerated

›Pregabalin

›Renal dosing adjustments

›Nociceptive pain

›Acetaminophen

›Max daily dose per local policy

›Opioids

›Use with caution

›Respiratory depression risk

›DVT prophylaxis

›Mechanical prophylaxis

›Intermittent pneumatic compression

›Pharmacologic prophylaxis if no contraindication

›Low molecular weight heparin per local protocol

›Nutrition and swallowing

›Swallow evaluation

›If bulbar symptoms

›Enteral feeding

›Early if prolonged weakness expected

›Skin and contracture prevention

›Reposition schedule

›Pressure injury prevention

›Range of motion program

›Daily stretching

Evidence levels and guideline statements

›Immunotherapy evidence

›IVIg or plasma exchange improves recovery when started early

›Class I recommendation in major neurology guidelines

›IVIg and plasma exchange have similar efficacy in typical severe GBS

›Class I recommendation in major neurology guidelines

›Corticosteroids alone do not improve outcomes

›Class I recommendation against use

›ED and acute care considerations

›Early ICU triage based on declining respiratory mechanics

›ACEP Level B style recommendation for escalation based on objective respiratory measures

›Avoid succinylcholine in neuromuscular paralysis

›ACEP Level B style recommendation based on safety signal and case evidence

09Special Populations/sp43

Pregnancy

›Pregnancy specific considerations

›Maternal physiology

›Lower baseline FVC in late pregnancy

›Earlier respiratory decompensation risk

›Immunotherapy selection

›IVIg favored

›Avoids central line and hypotension risk

›Plasma exchange feasible with specialist support

›Maternal hypotension risk

›Fetal considerations

›Fetal monitoring in viable gestations

›Obstetric consultation early

›Delivery planning

›Mode based on obstetric indications

›Regional anesthesia considerations

›Neuraxial decision individualized

Geriatric

›Older adult considerations

›Higher baseline comorbidity burden

›Lower physiologic reserve for ventilation

›Autonomic instability risk

›Arrhythmia monitoring priority

›Medication adverse effects

›IVIg thrombosis risk higher

›Hydration and mobility strategy

›Gabapentinoids delirium risk

›Start lower dose

›Rehabilitation needs

›Early mobilization planning

Pediatrics

›Pediatric specific considerations

›Presentation differences

›Refusal to walk

›Irritability from pain

›Dosing

›IVIg 2 g/kg total course

›0.4 g/kg/day for 5 days common

›Plasma exchange

›Specialized pediatric center

›Respiratory thresholds

›Weight based FVC thresholds

›Trend over absolute value

›Safeguarding and schooling

›Return to school plan

›Activity restrictions until strength recovery

10Background/b41

Epidemiology

›Incidence and demographics

›Annual incidence about 1 to 2 per 100,000

›Increases with age

›Male predominance

›Slightly higher than female

›Triggers

›Antecedent infection within 6 weeks common

›Campylobacter jejuni frequent

›Vaccination association rare

›Absolute risk low

Pathophysiology

›Immune mediated peripheral neuropathy

›Molecular mimicry

›Antibodies cross react with nerve components

›Demyelinating injury

›Conduction slowing and block

›Axonal injury

›Reduced compound muscle action potentials

›Clinical variants

›AIDP

›Demyelinating features on nerve conduction

›AMAN

›Pure motor axonal

›AMSAN

›Motor and sensory axonal

›Miller Fisher syndrome

›Cranial nerve predominant

Therapeutic Considerations

›Treatment timing

›Early IVIg or plasma exchange improves outcomes

›Greatest benefit within 2 weeks of onset

›Nonambulatory up to 4 weeks

›Benefit may persist later in severe cases

›Supportive care impact

›ICU level monitoring reduces preventable complications

›Dysautonomia related sudden death prevention

›Early rehabilitation improves functional recovery

›Contracture prevention

›Prognosis

›Most patients recover substantially over months

›Residual weakness possible

›Mortality low with modern critical care

›Higher with severe dysautonomia and respiratory failure

11Patient Discharge Instructions/pdi18

Copy discharge instructions

›Discharge counseling

›Most suspected GBS requires admission

›Discharge only with specialist agreement

›Activity and safety

›No driving until cleared

›Fall precautions at home

›Follow-up plan

›Neurology appointment scheduled

›Physiotherapy referral if weakness persists

›Return immediately for

›New or worsening shortness of breath

›Trouble swallowing

›Weak cough or choking

›Rapidly worsening weakness

›Fainting or palpitations

›Chest pain

›Inability to urinate

›New fever with severe headache after IVIg

12References/r15

Clinical guidelines and evidence sources

›Evidence sources

›American Academy of Neurology guidance on immunotherapy in GBS

›IVIg efficacy in severe GBS

›Plasma exchange efficacy in severe GBS

›Cochrane reviews on IVIg and plasma exchange

›Similar effectiveness in severe GBS

›Timing benefit early disease

›Brighton Collaboration diagnostic criteria for GBS

›Clinical features

›CSF and electrophysiology support

›Respiratory monitoring and ICU triage literature for GBS

›FVC and NIF thresholds for impending failure

›Clinical management system instructions source

›Formatting and nesting requirements

›Evidence level labeling requirements

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Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

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