Guillain-Barre syndrome

Alternative names

Definition

Causes, incidence, and risk factors

Guillain-Barre syndrome is an acute type of nerve inflammation. The inflammation damages portions of the nerve cell, resulting in muscle weakness or paralysis and sensory loss. The damage usually includes loss of the myelin sheath of the nerve (demyelination ), which slows the conduction of impulses through the nerve.

The damage can also cause denervation (kill the axon part of the nerve cell), which stops nerve function entirely. Without the axon, messages cannot be transferred from one nerve cell to another.

The exact cause of this disorder is unknown. It may occur at any age but is most common in people of both sexes between the ages 30 and 50. It often follows a minor infection, usually a respiratory (lung) infection or gastrointestinal (gut) infection. Signs of the original infection have usually disappeared before the signs of Guillain-Barre begin.

Guillain-Barre syndrome may occur in association with viral infections like mononucleosis, AIDS , and herpes simplex or after infections with bacteria, such as mycoplasma and some types of diarrhea. Sometimes Guillain-Barre occurs after recent surgery or vaccinations (such as rabies and swine flu vaccines) or in association with other medical problems such as systemic lupus erythematosus or Hodgkin's disease .

Symptoms

The disorder progresses rapidly (from days to a few weeks), causing w eakness or paralysis in a symmetrical manner. As weakness starts in the legs and then spreads to the arms, it is referred to as ascending paralysis. At the same time, patients may notice tingling, foot or hand pain, and clumsiness. As paralysis worsens, the patient may require assisted ventilation in order to breathe.

The phases of the illness include an initial phase of rapid worsening that may take only a few hours to reach the most severe symptoms. This phase can last up to 3 weeks. This is followed by a plateau phase of no changes, then a recovery phase where symptoms improve over days to 6 months or longer.

Typical symptoms include the following:

• Muscle weakness or paralysis (the most common symptom) or uncoordinated movements
  • Weakness begins in the feet and legs and may progress upward to the arms and cranial (head) nerves
  • May progress rapidly over 24 to 72 hours
  • May begin in the arms and progress downward
  • May occur in the arms and legs at the same time
  • May occur in the cranial nerves only
  • May not occur (mild cases)
• Sensation changes
  • Numbness , decreased sensation
  • Tenderness or muscle pain (may be a cramp-like pain)
  • Usually accompanies or precedes muscle weakness
  • May not occur at all

• Blurred vision
• Difficulty moving face muscles
• Clumsiness and falling
• Palpitations (sensation of feeling heartbeat)
• Muscle contractions

• Difficulty swallowing
• Drooling
• Difficulty breathing
• Breathing, absent temporarily
• Feeling unable to take a deep breath
• Fainting

Signs and tests

A history of increasing muscle weakness and paralysis may indicate Guillain-Barre syndrome, especially if there was a recent illness.

Neurological examination shows muscle weakness and may indicate dysfunction of the control of involuntary (autonomic) body functions such as blood pressure and heart rate. Sensory loss may be minimal, even when sensory changes are present.

There may be evidence of decreased breathing ability caused by paralysis of the breathing muscles and a decrease in deep tendon reflexes in the arms and legs.

• An NCV ( nerve conduction velocity ) shows demyelination .
• An EMG (a test of electrical activity in muscles) shows lack of nervous stimulation.
• A CSF (cerebrospinal fluid) examination may be abnormal, showing increase in protein without increase in white blood cell count .
• An ECG may show abnormalities in some cases.

Treatment

Support Groups

Guillain-Barre Syndrome Foundation International

Expectations (prognosis)

Complications

• Breathing difficulty ( respiratory failure)
• Aspiration of food or fluids into the lungs
• Pneumonia
• Increased risk of infections
• Deep vein thrombosis
• Permanent loss of movement of an area
• Contractures of joints or other deformity

Calling your health care provider

Update Date: 7/17/2002