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side by side comparison

Myasthenia Gravis vs Guillain-Barré Syndrome: Descending vs Ascending Weakness

Both diseases cause progressive weakness that can paralyze the diaphragm, but one starts at the eyes and works down while the other starts at the feet and climbs up. Picking the wrong direction on NCLEX means you'll miss the respiratory decline trajectory and choose the wrong intervention.

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Comparison

Side-by-side2 compared
Focus
Dimension
Myasthenia Gravis
Guillain-Barré
Pathophysiology & onset
  • Autoimmune anti-AChR antibodies at NMJ
  • Chronic, fluctuating course
  • Demyelination after GI/resp infection
  • Acute onset over days
  • Weakness peaks by 2–4 weeks
Signs & symptoms
  • DESCENDING: eyes → bulbar → limbs
  • ★Worsens with use, improves with rest
  • ★ASCENDING: legs → trunk → arms
  • Weakness not relieved by rest
Diagnostics
  • Positive anti-AChR antibodies
  • EMG: decremental response
  • ★CSF: ↑ protein, normal WBC
  • Absent deep tendon reflexes
Respiratory priorities
  • Monitor serial NIF & vital capacity
  • Intubate if VC < 15 mL/kg
  • Myasthenic crisis: sudden vent failure
  • Monitor serial NIF & vital capacity
  • Intubate if VC < 15 mL/kg
Treatment
  • Pyridostigmine
  • thymectomy
  • Plasmapheresis or IVIG
  • Plasmapheresis or IVIG
  • ★NO anticholinesterases
Patient teaching
  • Pyridostigmine on time, before meals
  • Pace activities, rest between tasks
  • Recovery is gradual over weeks–months
  • PT/OT, DVT prevention during paralysis
Crisis — escalate
  • Myasthenic crisis: undermedication
  • Cholinergic crisis: overmed (SLUDGE)
  • Resp failure as paralysis ascends
  • Autonomic instability: BP/HR swings
Prognosis
  • Chronic — managed not cured
  • Near-normal lifespan with treatment
  • Most recover; some residual weakness
Pathophysiology & onset

Myasthenia Gravis

  • Autoimmune anti-AChR antibodies at NMJ
  • Chronic, fluctuating course

Guillain-Barré

  • Demyelination after GI/resp infection
  • Acute onset over days
  • Weakness peaks by 2–4 weeks
Signs & symptoms

Myasthenia Gravis

  • DESCENDING: eyes → bulbar → limbs
  • ★Worsens with use, improves with rest

Guillain-Barré

  • ★ASCENDING: legs → trunk → arms
  • Weakness not relieved by rest
Diagnostics

Myasthenia Gravis

  • Positive anti-AChR antibodies
  • EMG: decremental response

Guillain-Barré

  • ★CSF: ↑ protein, normal WBC
  • Absent deep tendon reflexes
Respiratory priorities

Myasthenia Gravis

  • Monitor serial NIF & vital capacity
  • Intubate if VC < 15 mL/kg
  • Myasthenic crisis: sudden vent failure

Guillain-Barré

  • Monitor serial NIF & vital capacity
  • Intubate if VC < 15 mL/kg
Treatment

Myasthenia Gravis

  • Pyridostigmine
  • thymectomy
  • Plasmapheresis or IVIG

Guillain-Barré

  • Plasmapheresis or IVIG
  • ★NO anticholinesterases
Patient teaching

Myasthenia Gravis

  • Pyridostigmine on time, before meals
  • Pace activities, rest between tasks

Guillain-Barré

  • Recovery is gradual over weeks–months
  • PT/OT, DVT prevention during paralysis
Crisis — escalate

Myasthenia Gravis

  • Myasthenic crisis: undermedication
  • Cholinergic crisis: overmed (SLUDGE)

Guillain-Barré

  • Resp failure as paralysis ascends
  • Autonomic instability: BP/HR swings
Prognosis

Myasthenia Gravis

  • Chronic — managed not cured
  • Near-normal lifespan with treatment

Guillain-Barré

  • Most recover; some residual weakness

★ marks the fact that sets a column apart.

Clinical Pearl

MG drops Down from the eyes; GBS Gets up from the Ground — both can stop breathing.

Component Topics

Guillain-Barre SyndromeMyasthenia Gravis

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