Guillain-Barre Syndrome

Signs and symptoms
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 * Dysautonomia: present in 38% of patients in one study, not more common in demyelinating or axonal forms. Other studies reportely range from 10-67% prevalence.
 * Ileus (42%)
 * Hypertension (39%)
 * Hypotension (37%)
 * Fever (29%)
 * Sustained tachycardia (26%)
 * Urinary retention (24%)
 * Pupillary dysfunction (14%)
 * Sweating dysfunction (10%)
 * Hypothermia (6%)
 * Orthostatic hypotension (6%)
 * Bradycardia (1%)

Protein
Elevated protein is not sensitive in the first 7 days after onset of symptoms. Elevated protein defined as >60 mg/dL was only 47% sensitive in the first week, 76% sensitive in the second week, and was 96% sensitive thereafter. Defined at >45 mg/dL was 70% sensitive in the first week, 87% sensitive in the second week, and 100% sensitive thereafter.

Anti-glycolipid antibodies
Antibodies are present in 40% of patients with GBS after influenza, and 62% of patients with GBS after campylobacter.

Anti-GQ1b
More common in those with GBS after influenza (24%) than after campylobacter (9%).

Anti-GT1a
More common in those with GBS after influenza (24%) than after campylobacter (18%).

Influenza
The most common antibodies associated with GBS after influenza are anti-GQ1b (24%) and anti-GT1a (24%) but various other antiglycolipid antibodies can be present. The Miller-Fischer variant is more common in this disorder than campylobacter-associated GBS. There were no cases of acute motor axonal neuropathy after influenza, but 60% of cases were clearly AIDP. Sensory disturbances, ataxia, and cranial nerve deficits are more common with GBS after influenza than after campylobacter.

Surgery
In a large series of 8,364 cases with GBS, the OR for having undergone a surgical procedure in the 60 days prior to presentation was 1.53 (95% CI 1.25-1.88), even when no infection was identified during the hospitalization (OR 1.40, 95% CI 1.12-1.73). Surgery on bones and digestive organs carried all of the risk with OR 2.78 (95% CI 1.68-4.60) and 2.36 (1.32-4.21) respectively. As anesthesia type was not collected in the database in this study, it is now known how much of this association might be driven by anesthesia.

Treatment
Treatment with IVIG or plasmapheresis and not corticosteroids is a Neurocritical Care Society Clinical Performance Measure.

Posterior reversible encephalopathy syndrome (PRES)
Dysautonomia may be a risk factor for development of this (OR 8.71, 95% CI 0.99-76.17).

Dysautonomia
See signs and symptoms section above. Risk factors include: Dysautonomia in turn is associated with:
 * Mechanical ventilation (OR 6.93, 95% CI 3.39-14.15)
 * Neck flexor weakness (OR 4.51, 95% CI 2.25-9.05)
 * Low CMAP amplitudes, <20% lower limit of normal (OR 3.40, 95% CI 1.69-6.86)
 * Quadriparesis (OR 2.99, 95% CI 1.57-5.69)
 * Bulbar weakness (OR 2.86, 95% CI 1.54-5.30)
 * Cardiogenic complications (OR 10.62, 95% CI 1.25-90.11)
 * PRES (OR 8.71, 95% CI 0.99-76.17)
 * SIADH (OR 3.34, 95% CI 1.43-7.78)
 * Longer hospital length of stay (33 vs 12 days on average)
 * Discharge to SNF (OR 2.55, 95% CI 1.35-4.80) or death (5.6% with dysautonomia vs 0% without in one study)

SIADH
This may be more common in patients with dysautonomia (OR 3.34, 95% CI 1.43-7.78)

Patient factors associated with worsened ability to ambulate

 * Age (higher)
 * MRC sum score (higher)
 * GBS disability score (higher)
 * Preceding diarrhea (within 4 weeks)

Erasmus GBS Outcome Score (2007)
This score uses the GBS disability score and other clinical characteristics at 2 weeks to predict prognosis of ambulation. It was developed in a derivation set of 388 patients with GBS from centers in Europe and validated in another 374 patients from centers in Europe and North America.

Modified Erasmus GBS Outcome Score (2011)
This outcome score uses the examination at one week after hospital admission after onset to predict prognosis. It was derived from a 397 patient cohort and validated in a 191 patient cohort, both from Europe

GBS Disability Score
This score was created in 1978 for use in a trial on steroids in acute polyneuropathy. It is a grading scale meant to categorize different prognoses in Guillain-Barre syndrome.