Guillain-Barré syndrome history and symptoms


 * Associate Editors-In-Chief: Priyamvada Singh, MBBS [mailto:psingh@perfuse.org]

Overview
Guillain-Barré syndrome (GBS) is an acute, autoimmune, polyradiculoneuropathy affecting the peripheral nervous system, usually triggered by an acute infectious process. Patient may present with an antecedence of mild infection of respiratory or gastrointestinal infections that may disappear before the onset of weakness. Many patients also give a history of pins and needles sensation before the onset of weakness of limbs. Symmetrical, bilateral, weakness of lower limbs followed by upper limb, trunk and cranial nerve may be seen. Sensory symptoms are usually mild and patients may complain of decreased or increased pain sensation, decreased touch and difficulty walking (loss of position sense) depending on stage and type of GBS. Autonomic involvement in form of urinary retention, constipation and awareness of own's heartbeat can be found. Cranial nerve involvement in form of blurred vision, facial drooping, difficulty in swallowing and speaking can be seen.

History

 * Patients may present with a history of antecedence benign infection of gut or respiratory tract, 2-4 weeks prior to the development of symptoms . However, these infections usually resolve before onset of weakness.
 * Symptoms can get worse very quickly. It may take only a few hours to reach the most severe symptoms, however weakness increasing over several days is also common.
 * The mean time to the clinical function peak is 2 weeks, with most of the patients reaching a nadir by 4 weeks.
 * This is usually followed by a plateau phase characterized by persistent, unchanging symptoms.
 * The plateau phase may last for days before initiation of gradual symptoms improvement.
 * Recovery usually starts 2-4 weeks after the progression of symptoms ceases.
 * The mean time to clinical recovery is 15-20 weeks

Symptoms

 * Fever is uncommon and, and if it is present, another cause should be suspected.
 * The initial symptoms in many patients may be tingling, numbness or clumsiness sensation of the hands and foot.
 * These may start with fingertips and toes and can progress to wrist and ankles but not further.

Motor

 * The initial symptoms may be followed by development of weakness. The weakness may be characterized by the following features:
 * It usually affects the legs first, and rapidly progresses (hours to days) in an ascending fashion to involve trunk, upper limb, face, and other parts of the body.
 * Patients generally notice weakness in their legs, manifesting as "rubbery legs" or legs that tend to buckle easily.
 * Proximal muscles are affected more commonly and earlier than distal muscles. The patient may presents with difficulty in standing from sitting position and walking
 * The weakness usually affects both sides of the body (bilateral, symmetrical).
 * It may rarely begin in the arms and legs at the same time
 * It may rarely start in the arms and move downward
 * In mild cases, there may be no weakness or paralysis
 * Respiratory difficulties presenting secondary to respiratory muscle weakness may be seen. Most patients require hospitalization and about 30% require ventilatory assistance.

Sensory

 * Loss of touch, difficulty walking (position sense), pain and temperature sensation may present. Loss of pain and temperature sensation is usually mild.
 * On contrary, patient may present with deep aching pain usually in the weakened muscles, which they compare to the pain from overexercising. The causes for the pain are uncertain however, nerve injury and prolonged immobilization can be considered as possible causes
 * The common sites for pain are: Shoulder, back, thigh and buttock

Autonomic

 * Dizziness on standing from sitting or lying position (orthostatic hypotension)
 * Awareness of self heartbeat (Palpitations)
 * Increased or no sweating.
 * Difficulty or urinary retention.
 * Constipation secondary to bowel paralysis.

Cranial nerve

 * Usually symptoms due to involvement of cranial nerves follows weakness of limbs and trunk. However, in the Miller-Fisher variant of GBS cranial nerve are the first to get involved followed by limb involvement.
 * Blurred vision, double vision
 * Eye movement abnormalities are not commonly seen in ascending GBS, but are a prominent feature in the Miller-Fisher variant
 * Difficulty in swallowing speaking and drooling of saliva.
 * Facial weakness may also be seen.
 * Uncoordinated movements presenting as clumsiness in walking and history of fall may be seen.

Emergency symptoms (seek immediate medical help)

 * Difficulty breathing
 * Difficulty swallowing
 * Drooling
 * Fainting
 * Feeling light-headed when standing