EM · Neuromuscular junction disorders
Guillain-Barré syndrome and myasthenia gravis
Also known as Guillain-Barré syndrome · GBS · Acute inflammatory demyelinating polyradiculoneuropathy · AIDP · Myasthenia gravis · MG · Myasthenic crisis · Miller-Fisher syndrome
Guillain-Barré syndrome — the acute ascending flaccid paralysis with areflexia and autonomic instability, the respiratory-failure thresholds (FVC under 20 mL/kg or NIF under minus 30 cmH2O), the albuminocytologic dissociation on the CSF, and the IVIG 0.4 g/kg/day for 5 days or plasma exchange; and myasthenia gravis — the fatigable weakness (ptosis, diplopia, bulbar), the AChR antibody, the neostigmine and ice-pack tests, the pyridostigmine 60 mg PO, and the IVIG or plasma exchange for the myasthenic crisis. The GBS-versus-MG-versus-Lambert-Eaton differential. ACEM-primary, globally tagged.
Practise this topic
On this page & tools
Your progress
Saved locally on this device.
10 MCQs with explanations
Target exams
Red flags
Meet the patient
A 54-year-old man arrives with four days of progressive weakness that began in his feet and has climbed to his thighs and hands. He had a diarrhoeal illness two weeks ago. He is areflexic in all four limbs, with bilateral facial weakness and a weak cough that cannot clear his drooling secretions. RR 24, SpO2 96 per cent on room air, FVC 22 mL/kg and falling.[1]
The patient talks and keeps his saturation until the FVC is critically low — the bedside appearance lies. Measure the FVC every 2 to 4 hours; the trend, not the snapshot, decides the airway.[2]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Emergency Medicine fellowship atlas.
References8Show ledgerHide ledger
- [1]van den Berg B, Walgaard C, Drenthen J, et al. Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis Nat Rev Neurol, 2014.PMID 25023340
- [2]Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome Lancet, 2016.PMID 26948435
- [3]Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain-Barré syndrome Cochrane Database Syst Rev, 2017.PMID 28241090
- [4]Doets AY, Hughes RA, Brassington R, et al. Pharmacological treatment other than corticosteroids, intravenous immunoglobulin and plasma exchange for Guillain-Barré syndrome Cochrane Database Syst Rev, 2020.PMID 31981368
- [5]Lowie BJ Fluctuating, but Not Forgotten: Recognizing Neuromuscular Junction Disorders Emerg Med Clin North Am, 2026.PMID 41895886
- [6]Narayanaswami P, Sanders DB, Wolfe GI, et al. International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update Neurology, 2021.PMID 33144515
- [7]Lacomis D. Myasthenic crisis Neurocrit Care, 2005.PMID 16377829
- [8]Motomura M, Ike K, Kitanosono H, et al. [How to Diagnose Lambert-Eaton Myasthenic Syndrome Patients Early: A Systematic Review of Japanese Case Reports] Brain Nerve, 2026.PMID 41700072