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Condition/Disorder Synonyms


  • Landry-Guillain-Barré-Strohl syndrome

  • Acute inflammatory demyelinating polyneuropathy

  • Acute demyelinating polyneuritis


ICD-9-CM Code


  • 357.0 Acute infective polyneuritis


ICD-10-CM Code


  • G61.0 Guillain-Barré syndrome


Preferred Practice Pattern


Key Features




  • Demyelination of the peripheral nervous system, resulting in quickly progressing paralysis beginning distally, potentially ending full quadriplegic presentation with respiratory failure2,3,4


Essentials of Diagnosis


  • Most common bacteria identified with Guillain-Barré syndrome (GBS) is Campylobacter jejuni; other common infections include cytomegalovirus and Epstein-Barr virus

  • 60% of cases have preceding upper-respiratory illness or vaccination 1 to 3 weeks prior to onset


General Considerations


  • Two forms of GBS are common, though several other variants exist

    • Non-axonal form

      • Peripheral nerves undergo demyelination, but no damage to axons

      • High likelihood of regaining full function with appropriate medical and therapeutic intervention

    • Axonal form

      • Axon of the peripheral nerve is damaged, does not re-myelinate

      • Function through that nerve is lost, patient will likely have permanent functional loss of associated muscle

  • Rapid progression from onset to potential respiratory failure; should be identified and treated very quickly

  • Most patients show gradual return of strength beginning 2 to 4 weeks after the point at which progression of the disease stops (“nadir”)

  • Approximately 50% of patients experience dysfunction of the autonomic nervous system, including

    • Low cardiac output

    • Cardiac dysrhythmias

    • Marked fluctuation in blood pressure

    • Poor venous return

    • Bowel and bladder retention




  • Males and females of all ages susceptible

  • Approximately 4 in 100,000 people afflicted each year


Clinical Findings


Signs and Symptoms


  • Progressive weakness in distal to proximal direction resulting in quadriplegia

    • Decreased muscle strength, recruitment, endurance

    • Decreased active range of motion (AROM)

    • Decreased sensation in stocking/glove pattern

  • Loss of deep tendon reflexes, initially at the calcaneal (Achilles) tendon

  • Deep muscle aching

  • Respiratory failure


Functional Implications


  • Bed mobility, transfers, gait, basic and complex ADLs

  • Decreased independence with all self-care

  • Decreased ability to interact with environment physically, verbally, sometimes visually (if cranial nerves controlling vision are affected)


Possible Contributing Causes


  • Definitive cause unknown

  • Campylobacter jejuni most common bacterium associated with GBS

  • Pre-morbid respiratory illness (severe cold or flu) is also a common contributing cause


Differential Diagnosis


  • Spinal cord compression (myelopathy)

  • Miller-Fisher syndrome (GBS variant)

  • Chronic inflammatory demyelinating polyradiculoneuropathy

  • Acute spinal cord disease

  • Myasthenia gravis

  • Sarcoidosis

  • Upper motor neuron (UMN) disorder

  • Tick paralysis

  • Poliomyelitis

  • Polyarteritis nodosa

  • Polyneuropathy of critical illness

  • Transverse myelitis

  • Cervical stenosis

  • Spinal tumor

  • Diabetic neuropathy


Means ...

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