Guillain-Barre Syndrome

The answer first

Guillain-Barre syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy. The clinical signature is progressive, symmetric, ascending weakness with areflexia that reaches its nadir within 4 weeks. It is the most common cause of acute generalized paralysis since polio was eradicated, and it is a medical emergency: around one in four patients needs mechanical ventilation, and autonomic failure causes a substantial share of deaths. ^[1]

Three facts organise everything else: ^[1]

1. It is treatable. Both intravenous immunoglobulin (IVIG) and plasma exchange speed recovery if given within 2-4 weeks of onset. Corticosteroids do not work and may worsen the disease.
2. The threat to life is respiratory and autonomic, not the weakness itself. Bedside lung function monitoring (FVC, MIP, MEP), not the strength of the grip, decides who goes to ICU and who is intubated.
3. The diagnosis is clinical and supported by CSF and nerve conduction studies. A normal CSF in the first week does not exclude GBS — albuminocytologic dissociation appears after 1-2 weeks. ^[1]

The organising principle on the ward is: diagnose early, monitor lung function relentlessly, treat with IVIG or plasma exchange (not both), never give steroids, and watch the clock for the 8-week boundary that converts the diagnosis to CIDP. ^[1]

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References15ShowHide

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