Ver el código de «Guillain-Barre syndrome»

==Background==
*Acute polyneuropathy due to immune-mediated peripheral nerve myelin sheath destruction
*Although there is often a motor component, patients can also present with sensory deficits.  
*Associated with [[viral syndrome|viral]] or febrile illness, [[Campylobacter]] infection, or vaccination
*Symptoms at worst 2-4wk after onset, then plateau for 2-4wk, then remit from wks-months 
*Associated with [[Campylobacter jejuni]], [[cytomegalovirus]], [[Epstein-Barr virus]], and [[Mycoplasma pneumoniae]]

==Clinical Features==
*[[Viral syndrome|Viral illness]] → ASCENDING, symmetric [[weakness]] or paralysis and loss of DTRs
*Little or no sensory involvement 
*May progress to diaphragm resulting in need for mechanical ventilation (33% of patients)
*Autonomic dysfunction occurs in 50% of patients
*In pediatrics, may present with pain (typically in the thighs) and refusal to walk

===Required===
*Progressive [[weakness]] of more than one limb
*Areflexia

===Suggestive===
*Progression over days to weeks
*Recovery beginning 2–4 wk after cessation of progression
*Relative symmetry of symptoms
*Mild sensory signs and symptoms
*CN involvement ([[Bell's Palsy]], [[dysphagia]], [[dysarthria]], [[ophthalmoplegia]])
*Autonomic dysfunction
**[[Tachycardia]], [[bradycardia]], [[dysrhythmias]], wide variations in BP, postural [[hypotension]]
**[[Urinary Retention]]
**[[Constipation]]
**Facial flushing
*Absence of [[fever]] at onset

===Variants and Subtypes===
*Multiple variants<ref>Ho TW et al. 
Guillain-Barrésyndrome in northern China. Relationship to Campylobacter jejuni infection and anti-glycolipid antibodies. Brain. 1995;118 ( Pt 3):597. </ref><ref>Sumner AJ et al. The physiological basis for symptoms in Guillain-Barrésyndrome. Ann Neurol. 1981;9 Suppl:28. </ref>
*Acute inflammatory demyelinating polyneuropathy
**most common type
**progressive symmetric muscle [[weakness]] 
**often with decreased deep tendon reflexes due to peripheral nerve involvement
*Acute motor axonal neuropathy
**often associated with [[campylobacter]] infections
**only motor involvement
*Acute motor and sensory axonal neuropathy
**presence both motor and sensory involement
*Miller-Fisher Syndrome
**Associated with [[campylobacter]] infection
**More likely to be preceded by [[diarrhea]] than viral prodrome
**Presence of ''ophthalmoplegia'' with [[ataxia]] and areflexia
**Weakness is less severe but DESCENDING; disease course milder than classic GBS
**May present similarly to [[botulism]], which is also descending paralysis

==Differential Diagnosis==
{{Weakness DDX}}

==Evaluation==
*[[LP]]
**'''Albumin-cytological dissociation of [[CSF]] (high protein (>45) and low WBC count (<10)) is most common
**Patients with HIV can have a pleocytosis<ref name="Rosen">Bunney EB, Gallagher EJ: Peripheral Nerve Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 105:p 1400-1401.</ref><ref>Brannagan TH et al. HIV-associated Guillain-Barré syndrome. J Neurol Sci. 2003;208(1-2):39. </ref>'''
*Typical findings on electromyogram and nerve conduction studies
*MRI: Selective enhancement of the anterior spinal nerve roots is suggestive<ref name="Rosen" />

==Management==
===[[IVIG]]===
*Treat non-ambulatory patients within 2 weeks of symptom onset

===[[IVIG]] vs [[Plasmapheresis]]===
*IVIG associated with [[thromboembolism]] and aseptic [[meningitis]]
*Plasmapheresis associated with greater hemodynamic instability, lower rate of relapse
*Combined IVIG and plasmapheresis no better than single therapy (IVIG or plasmapheresis)
*IVIG preferred due to convenience and availability

===Intubation indications===
*Vital capacity <15mL/kg
*Negative Inspiratory Force < 30 cm H2O
*PaO2 <70 mm Hg on room air
*Bulbar dysfunction (difficulty with breathing, swallowing, or speech)
*Aspiration
*''Avoid'' [[succinylcholine]] during intubation, as this may cause severe [[hyperkalemia]]

==Disposition==
*Admit

===Indications for admission to ICU===
*Autonomic dysfunction
*Bulbar dysfunction
*Initial vital capacity <20 mL/kg
*Initial negative inspiratory force <–30 cm of water
*Decrease of >30% of vital capacity or negative inspiratory force
*Inability to ambulate
*Treatment with plasmapheresis
*Anticipated clinical course requiring mechanical [[ventilation]]

==See Also==
*[[Weakness]]

==References==
<references/>

[[Category:Neurology]]