Guillain-Barre Syndrome

Authors
Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Resources

Types

Acute Axonal GBS

  • Acute areflexic polyneuropathy clinically similar to typical GBS but characterized pathologically by widespread and severe axonal degeneration1.
  • In their initial report they described five patients with a rapid evolution of polyneuropathy and slow and poor recovery. Unlike the common form of demyelinating GBS, muscle atrophy became apparent relatively early in the axonal form (within weeks). The defining feature was the presence of numerous electrically inexcitable motor nerves and signs of extensive denervation. This finding could also signify a distal demyelinating block from which complete recovery is possible (Triggs et al). Nevertheless, most cases of abrupt and severe denervating paralysis, particularly if postinfectious, are caused by the axonal form of GBS (Ropper, 1986b)

Clinical Presentation

Onset

Sx Location

  • Whereas in most patients the paralysis ascends from legs to trunk, to arms, and then to cranial regions1
  • Portions of the typical clinical picture of GBS appear in isolated or abortive form and are a source of diagnostic confusion1.
  • In some cases, “the pharyngeal-cervical-brachial muscles may be affected first or constitute the entire illness, causing difficulty in swallowing with neck and proximal arm weakness”1

Timing

Symptoms reach peak of severity within 10 to 14 days

Ptosis, often with ophthalmoplegia, may be added. The differential diagnosis then includes myasthenia gravis, diphtheria, and botulism and a lesion affecting the central portion of the cervical spinal cord and lower brainstem.”1

Gait

GBS Disability Scale

Score Description
0 A healthy State
1 Minor symptoms and capable of running
2 Able to walk 10m or more without assistance but unable to run
3 Able to walk 10m across an open space with help
4 Bedridden or chairbound
5 Requiring assisted ventilation for at least part of the day
6 Dead

NMES

References

1.
Ropper AH, Samuels MA, Klein J, Prasad S. Adams and Victor’s Principles of Neurology. 12th ed. McGraw Hill; 2023.
2.
Kolar P. Clinical Rehabilitation. 1st ed. Dynamic Neurological Stabilization; 2014.

Citation

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