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Guillain–Barré syndrome (GBS)

(aka: Landry–Guillain–Barré–Strohl syndrome:
  • Most common cause of acute flaccid paralysis
  • Rapidly progressive ascending paralysis & areflexia
  • Autonomic dysfunction, CSF albumin-cytologic dissociation.
  • The sensory and motor systems may be equally affected. 
  • The paralysis moves rapidly from lower to upper areas.

Differential diagnosis:
  • Myasthenia gravis: Intermittent & worsened by exertion.
  • Multiple Sclerosis: CNS demyelination, hyperreflexia, multiple lesions on MRI, oligoclonal bands in CSF.
  • Botulism: Descending weakness fixed dilated pupils, food/wound toxin exposure & prominent cranial nerve dysfunction with normal sensation.
  • Tick paralysis: Ascending paralysis but spares sensation.
  • West Nile virus: Headache, fever, & asymmetric flaccid paralysis but spares sensation.
  • Transverse myelitis: Pain, weakness, abnormal sensation, urinary dysfunction, sensory level, hyperreflexia, spinal cord lesion on MRI.
  • CIDP: Chronic progression, relapses, requires long-term immunotherapy.
  • Spinal Cord Compression: Hyperreflexia, sensory level, MRI shows mass or compression.

 

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