Guillain-Barre syndrome typically begins with tingling and weakness in the feet and legs that spreads to the upper body and arms. In 10% of cases, symptoms start in the arms or face. As it progresses, muscle weakness can lead to paralysis over days or weeks. Paralysis is characterized by loss of deep tendon reflexes and may involve facial and respiratory muscles in 20-30% of severe cases, potentially requiring ventilatory support. Autonomic disturbances like fluctuations in blood pressure are also common. The disorder is predominantly a motor neuropathy but some sensory loss can precede muscle weakness.

1. Clinical Features of GBS
Fatihah

2. Guillain-Barre syndrome
often begins with tingling
and weakness starting in
your feet and legs and
spreading to your upper
body and arms.
In about 10% of people with
the disorder, symptoms begin
in the arms or face.
As Guillain-Barre syndrome
progresses, muscle weakness
can evolve into paralysis.

3. Hallmark – Paralysis with areflexia
• Symmetrical motor weakness
• Acute/rapid onset of paralysis with areflexia
• Over days or weeks
• Areflexia - loss of deep tendon reflex/jerk
• May also be hyporeflexia
• Weakness beginning distally – proximal rapidly
(Ascending paralysis)
• Rapid progress within maximum 4 weeks
• Paralysis is more marked proximal > distal

4. ….Very minimal Sensory involvement
• Predominantly motor, with or without sensory
• May precede muscle weakness
• Loss of pain sensation
• Distal paraesthesia
• Numbness

5. ……Paralysis
• 20-30% cases will involve facial and respiratory
muscle (rapid deterioriation, within hours)
• Difficulty in facial movements – chewing,
speaking, swallowing
• Difficulty breathing - Will require ventilatory
support
• In late and severe cases – bladder dysfunction
• At onset of weakness : no fever or
constitutional symptoms

6. Autonomic disturbances
• Common such as
1. Fluctuation of BP (tachycardia,bradycardia)
2. Postural hypotension
3. Facial flushing
4. Cardiac dysrhythmias

7. Pain – Early onset
• 50% of patient will have pain
• Located at the low back,neck, shoulder, buttocks, thighs
• Acute / deep aching pain in weak muscles
• Self limited

8. Miller-Fisher Syndrome
1. Ophtalmoplegia
2. Ataxia
3. Areflexia
• Preceded by diarrhea
(Campylobacter jejuni)

9. Bickerstaff’s brainstem encephalitis (BBE)
1. Altered consciousness
2. Paradoxical hyperreflexia
3. Ataxia
4. Ophtalmoparesis

10. Differential Diagnosis of GBS
Must exclude other causes of an acute neuromuscular paralysis either
clinically or through investigations

11. Differential Diagnosis
• Causes for neuromuscular paralysis : Poliomyelitis, botulism,
diphtheria, localized spinal cord syndromes, myasthenia gravis,
vasculitis, toxins (organophosphates, lead) , diphtheria, porphyria,
spinal cord or cauda equine syndrome etc
• Guidelines : Asbury & Cornblath Criteria

12. Asbury & Cornblath Criteria for GBS

14. Thank you!
References
1. Archit Boloor, Exam Prepatory Manuals for Undergraduates
Medicine
2. Davidson’s Principles and Practices of Medicine
3. https://www.mayoclinic.org/diseases-conditions/guillain-barre-
syndrome/symptoms-causes/syc-
20362793#:~:text=from%20Mayo%20Clinic-
,Symptoms,weakness%20can%20evolve%20into%20paralysis.
4. WHO website
5. Faqihah Hasnizam’s slides