Guillain-Barré Syndrome: A Demyelination Syndrome

First Things First (assess for & treat the following)

• In pts w/ acute paraparesis or quadriparesis evaluate for:
  • Myelopathy (spinal cord lesion)
    • Myelitis
    • Spinal cord compression
  • Peripheral nervous system (PNS) disorders
    • Guillain-Barré syndrome (GBS), particularly acute inflammatory demyelinating polyneuropathy (AIDP)
    • Mononeuropathy multiplex (vasculitis of PNS)
    • Acute intermittent porphyria
    • Acute critical illness neuropathy
    • Lumbosacral polyradiculopathy (cauda equina syndrome)
  • Neuromuscular junction disorders
    • Presynaptic
      • Botulism
      • Tick paralysis
      • Organophosphate poisoning
      • Drug-induced myasthenia gravis
    • Postsynaptic
      • Myasthenia gravis (myasthenic crisis)
  • Myopathy
    • Acute inflammatory myopathy (polymyositis or dermatomyositis)
    • Acute infectious myositis
    • Acute toxic/drug-induced myositis
    • Hypo- or hyperkalemic periodic paralysis
• If pt felt to have GBS:
  • Assess for & treat respiratory distress (dyspnea, orthopnea)
    • 30% of pts require intubation and mechanical ventilation.
    • Maintain head of bed > 30°
    • Obtain forced vital capacity (FVC) & negative inspiratory force (NIF)
  • Assess for & treat cardiac arrhythmias (ECG monitor), labile BP