Clinical Manifestations of Guillain-Barré Syndrome

1. Weakness
Classical clinical picture is ascending weakness and naturally symmetrical. Lower limbs are usually affected first before the upper limbs. Proximal musculature may be involved earlier than the more distal. Body, bulbar, and respiratory muscles can be affected as well. Respiratory muscle weakness with shortness of breath may be found, developed acute and lasts for few days to weeks. Severity can range from mild weakness to tetraplegia with ventilatory failure.

2. Involvement of cranial nerves
Cranial nerve involvement seen in 45-75% of patients with GBS. Cranial nerves III-VII and IX-XII may be affected. Public complaints may include the following; facial droop (Bell palsy can manifest), Diplopias, dysarthria, dysphagia, ophthalmoplegia, and pupillary disorders. Facial and oropharyngeal weakness usually appears after the body and legs are affected. Miller-Fisher variant of GBS subtype is unique because it starts with cranial nerve deficits.

3. Sensory Changes
Sensory symptoms are usually mild. In most cases, sensory loss tend to be minimal and variable. Most patients complain of paresthesia, anesthesia, or a similar sensory changes. Sensory symptoms often precede weakness. Paresthesia generally starts at the toes and fingertips, proceeds go to the top but generally does not widen out the wrist or ankle. Loss of vibration, proprioseptis, touch, and pain may be present distal.

4. Painful
In a study of pain in patients with GBS, 89% of patients reported pain caused by GBS at some time during the course of the disease. The most severe pain can be felt in the shoulder area, back, buttocks, and thighs, which can occur even with the slightest movement. The pain is often described as pain or throbbing. Dysesthetic symptoms observed in approximately 50% of patients during the course of their disease. Dysesthesias often described as burning, tingling, or a sensation Shocklike and often more common in the lower extremities than in the upper extremities.
 Dysesthesias can persist indefinitely in 5-10% of patients. Other common pain syndromes experienced by some patients with GBS are as follows;  Myalgic, visceral pain, and pain by tyang conditions associated with immobility (eg, pressure nerve palsy, decubitus ulcers).

5. Changes in autonomic nervous system
Involvement of the autonomic nervous system dysfunction in the sympathetic and parasympathetic systems can be observed in patients with GBS. Autonomous changes may include the following; Tachycardia, Bradycardia, Facial flushing, hypertension paroksimal, orthostatic hypotension, anhidrosis and / or diaphoresis urinary retention due to impaired urinary sphincter, since paresis stomach and intestinal dysmotility may be found. Dysautonomia more frequently in patients with weakness and severe respiratory failure.

6. Breathing
Forty percent of GBS patients are likely to have respiratory or oropharyngeal weakness. Typical complaints are often found is as follows: dyspnea on exertion, shortness of breath, difficulty swallowing, slurred Talk failure requiring ventilation support normal respiration occurs in up to one third of patients at some time during the course of their disease.

How to Diagnose Guillain-Barré Syndrome

     The characteristics of cerebrospinal fluid abnormalities strong advocate diagnosis: Protein CSS. Improved after 1 week of symptoms or an increase in the LP series; CSS cell count <10 MN/mm3; Variant (no increase in CSF protein after 1 week of symptoms and the number of cells CSS: 11-50MN/mm3). Electrodiagnostic picture that supports diagnosis is slowing of nerve conduction block even in 80% of cases. Usually the speed of conductivity approximately 60% of normal.


•    Guillain-Barre Syndrome•    Etiology of Guillain–Barré Syndrome•    Pathophysiology of Guillain-Barré Syndrome•    Medical Treatment and Therapy of Guillain–Barré syndrome•    How to Diagnose Guillain–Barré syndrome
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