Guillain-Barre Syndrome

A patient reports tingling in the feet two weeks after a respiratory infection — within days, that tingling could ascend to the diaphragm. Recognizing GBS early is a race against respiratory failure.

Guillain-Barré syndrome (GBS) is an acute, ascending, demyelinating polyneuropathy triggered by an autoimmune response, typically 1–3 weeks after a viral respiratory or GI infection (especially Campylobacter jejuni). The immune system attacks peripheral nerve myelin sheaths, causing symmetric weakness that starts in the lower extremities and climbs upward — legs, trunk, arms, cranial nerves, and potentially the diaphragm. This ascending paralysis pattern is the hallmark. The greatest danger is respiratory compromise: you monitor vital capacity and negative inspiratory force (NIF) serially. Intubation is anticipated when vital capacity drops below 15–20 mL/kg or NIF is weaker than −20 cmH₂O. Deep tendon reflexes are diminished or absent (areflexia). Autonomic dysfunction — labile blood pressure, cardiac dysrhythmias, urinary retention — is common and potentially lethal. CSF analysis classically shows albuminocytologic dissociation (elevated protein with normal cell count). Treatment includes plasmapheresis or IV immunoglobulin (IVIG) to shorten the course. Unlike ALS or MS, GBS is usually reversible; most patients recover over weeks to months, though residual weakness may persist. Nursing priorities center on respiratory monitoring, DVT prophylaxis, pain management (neuropathic pain is significant), and fall prevention during recovery.

Key Distinctions

Don't confuse GBS (ascending weakness, acute onset, reversible) with myasthenia gravis (fatigable weakness starting at the eyes/face, chronic, worsens with activity). Students mix up GBS and MS — GBS affects peripheral nerves with areflexia, while MS affects CNS myelin with hyperreflexia. Remember: GBS follows an infection and progresses over days, not years. Corticosteroids are NOT effective in GBS — unlike MS flares, where they are first-line.

Clinical Pearl

GBS climbs like a ladder — feet first, diaphragm last. When the ladder reaches the lungs, have the intubation tray ready. Ascending + areflexia + post-infection = GBS.