Skip to Main Content

++

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

++

Description

++

  • 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

++

Demographics

++

  • 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 ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.