http://www.bcm.tmc.edu/neurol/research/nmus/nmus3c1.html
Guillain-Barré syndrome is an acute illness involving the peripheral nervous
system that usually occurs two to three weeks after a flu-like disease or other
infections. It is mostly a motor neuropathy, meaning that its symptoms are
largely related to the involvement of the motor nerves. Despite the primarily
motor nature of the disease, the earliest symptoms may be numbness and tingling
felt in the lower extremities followed shortly by weakness of the distal muscles
of the lower extremities. The common early symptoms reported by patients are
those of tripping on the toes that later results in a footdrop. The weakness
usually ascends to involve the entire lower extremities and later the upper
extremities. The danger occurs when the weakness involves the muscles of
respiration. At that time prompt intubation and admission to the Intensive Care
Unit is required. Although Guillain-Barré syndrome is usually a self-limiting
illness, prompt recognition of the symptomatology and correct diagnosis are
required for intensive observation and therapeutic intervention.
The diagnosis of Guillain-Barré syndrome is suggested when the patient presents
with a history of ascending weakness and a physical examination consistent with
a primarily motor neuropathy. The diagnosis is confirmed with the performance of
a spinal tap, which usually shows elevation of the protein level in the spinal
fluid without an increase in the number of white cells and by an electromyogram.
All other conditions resembling Guillain-Barré syndrome must also be excluded.
Once the diagnosis is confirmed, treatment is initiated with intravenous gamma
globulin or plasma exchange. Both of these treatment modalities have been shown
to reduce the duration of illness and to affect the extent of final recovery.
When diagnosed early and appropriately treated, patients usually start
recovering within a few days. Full recovery usually occurs after two or more
months of the illness. The treatment, however, is not effective in all patients
and a few patients fail to recover full strength. Guillain-Barré syndrome is
usually a monophasic illness that rarely recurs.
Department of Neurology,
Baylor College of Medicine
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