Guillain-Barré Syndrome

Overview – Guillain-Barré Syndrome

Guillain-Barré syndrome (GBS) is an acute autoimmune polyneuropathy that typically follows a viral illness. It causes rapid, symmetrical, ascending weakness and paraesthesia due to demyelination of peripheral nerves. Although rare, GBS is a neurological emergency due to the risk of respiratory paralysis. This article provides a high-yield summary of the pathophysiology, clinical features, investigations, and management of Guillain-Barré syndrome for final-year medical students.

Definition

Guillain-Barré syndrome is an acute inflammatory demyelinating polyneuropathy (AIDP) affecting the peripheral nervous system, usually triggered by a recent viral or bacterial infection.

Aetiology

  • Post-infectious autoimmune response, commonly after:
    • Campylobacter jejuni (most classic)
    • CMV, EBV, HIV
    • Influenza
    • COVID-19
  • Often triggered 1–3 weeks post-infection

Pathophysiology

  • Molecular mimicry leads to T-cell mediated immune attack on myelin sheaths of peripheral nerves
  • Demyelination → slowed/blocked nerve conduction
  • Motor symptoms: Symmetrical ascending paralysis
  • Sensory symptoms: Paraesthesia, reduced proprioception, areflexia
  • Does not involve the CNS (differentiates from MS)

Clinical Features

  • History:
    • Recent viral illness (1–3 weeks prior)
  • Onset: Rapid (hours to days)
  • Symptoms:
    • Symmetrical ascending weakness (feet → hands → trunk)
    • Ascending paraesthesia
    • Areflexia
    • No fever
    • May progress to respiratory muscle weakness (life-threatening)
  • Red flags:
    • Respiratory difficulty
    • Bulbar involvement (dysphagia, dysarthria)
    • Autonomic instability (arrhythmias, BP swings)
Guillain-Barré Syndrome
Diagnosis and management of Guillain–Barré syndrome in ten steps. Nat Rev Neurol 15, 671–683 (2019). https://doi.org/10.1038/s41582-019-0250-9

Investigations

  • Lumbar puncture:
    • ↑ CSF protein, normal WCC (“albuminocytologic dissociation”)
  • Nerve conduction studies / EMG:
    • Slowed conduction velocity, demyelination pattern
  • Spirometry (bedside):

Management

  • Hospital admission: Monitor for respiratory failure and autonomic dysfunction
  • Ventilatory support if FVC <20 mL/kg or signs of respiratory compromise
  • IV Immunoglobulin (IVIG) OR plasmapheresis (equally effective if started early)
  • Supportive care:
    • DVT prophylaxis
    • Physiotherapy
    • Nutritional and psychological support

Complications

  • Respiratory failure (most common cause of death)
  • Autonomic dysfunction (arrhythmias, hypotension)
  • Long-term weakness or neuropathic pain
  • Risk of recurrence (~2–5%)

Differential Diagnosis

Summary

Guillain-Barré syndrome is an acute, post-infectious autoimmune neuropathy characterised by rapidly progressive, symmetrical ascending paralysis and areflexia. Early recognition and intervention with IVIG or plasmapheresis are essential to prevent respiratory failure. It is a clinical emergency with good recovery in most patients when managed promptly. For a broader context, see our Nervous System Overview page.

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