Guillain Barre syndrome

This is an immunologically-mediated, acute demyelinating polyradiculopathy. Viral infections and immunisations are common antecedents. The syndrome includes a progressive, areflexic motor weakness (often symmetrical, ascending and involving cranial nerves including facial, bulbar and extraocular) with progression over days to weeks. There are often minor sensory disturbances (e.g. paraesthesiae). Autonomic dysfunction is not unusual. There is no increase in cell count on CSF examination but protein levels usually rise progressively (>0.4 g/l). Nerve conduction studies show slow conduction velocities with prolonged F waves. Other features include muscle tenderness and back pain. The major contributors to morbidity and mortality are respiratory muscle weakness and autonomic dysfunction (hypotension, hypertension, arrhythmias, ileus and urinary retention).

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