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

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Last updated: April 27, 2010