How to Diagnose Guillain–Barré syndrome

To make the diagnosis of GBS used criterion is the most commonly used criteria from the National Institute of Neurological and Communicative Disorder and Stroke (NINCDS), namely:

I. These characteristics are necessary for diagnosis
A. The occurrence of progressive weakness and concerns of more than one limb. Weakness can only be a mild paresis in both legs, with or without mild ataxia to paralysis in all four limbs muscle, muscle, muscle bulbar, facial muscles and external opthalmoplegia.
B. Areflexia. Usually occurs distal areflexia with hyporeflexia in the proximal part.

II. The characteristics that strongly support the diagnosis GBS
A.Clinical characteristics
1. Progresivity of muscle paralysis spread quickly but stalled in 4 weeks.
2. Symmetric
3. Only mild sensory disturbance
4. Come with exposed brain nerves, brain nerves VII exposed to about 50% and often bilateral
5. Healing usually starts 2-4 weeks after cessation of progression of paralysis.
6. Disorders of the autonomic nervous Tachycardia and arrhythmias, postural hypotension, hypertension and vasomotor symptoms.
7. No febrile. At the beginning of paralysis patient has no fever anymore.

Other features:
 1. Start time paralyzed, still febrile
2. Sensory disturbance accompanied by pain
3. After 4 weeks still growing paralysis
4. Do not continue to deteriorate but also arises healing
5. There can be transient bladder paralysis or impaired
6. Attached central nervous

B. The characteristics of cerebrospinal fluid abnormalities was the diagnosis
1. The amount of protein in the cerebrospinal fluid increases start from weeks after the onset of symptoms.
2. The number of cells does not exceed 10/mm

 Other features:
1. Total protein did not increase 1-2 weeks after muscle weakness arises.
2. The number of cells 11-50 mononuclear cells / mm

 C. The characteristics of electrodiagnostic examination was supporting the diagnosis of GBS is a nerve conduction slowing or block.

III. The characteristics that make dubious diagnosis
1. Weaknesses remain asymmetric
2. Fixed a disturbance micturition and defecation
3. Micturition and defecation disturbance early
4. The number of cells in the cerebrospinal fluid> 50/mm
5. Presence of PMN cells in the cerebrospinal fluid
6. The existence of a clear boundary sensibility disorders

IV. Signs against GBS diagnosis
1. The existence of anamnesis use hexacarbon compounds, such as glue sniffing.
2. The presence of abnormal porphyrin metabolism such as acute intermittent porphyria.
3. Diphteri history, with or without myocarditis.
4. Signs of tin poisoning, characterized by upper limb weakness with wrist drop.
5. Just acquired sensory disturbance only.
6. The certainty of diagnosis, such as poliomyelitis, botulime, toxic polyneuropathy.

a. Cerebrospinal Fluid Examination
Seen the Albumino-Cytologic dissociation that is where there is an increase of high levels of protein without an increase in cell number. Gamma globulin is also increasing.
b. EMG examination, nerve conduction decreased, latency elongated, Response decreases.
c. Respiratory function tests


1. Poliomyelitis
Difference with SGB, poliomyelitis was not preceded by a respiratory infection, acute and strike quickly, paralysis unilateral, asymmetric, on examination of cerebrospinal fluid pleocytosis there, not a total cure and the prognosis is worse than the SGB.
2. Botulism
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