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Pediatric Guillain-Barre Syndrome Differential Diagnoses

  • Author: Marc P DiFazio, MD; Chief Editor: Amy Kao, MD  more...
Updated: Dec 11, 2014

Diagnostic Considerations

The differential diagnosis of GBS in childhood is primarily in the spectrum of progressive, symmetric weakness. In infants, botulism should be considered. Botulism is characterized not only by (descending) weakness but also by involvement of the extraocular muscles (ophthalmoplegia), miosis of the pupil and constipation. Pupillary abnormalities can be an important distinguishing feature unique to botulism.

When ophthalmoplegia is present, myasthenia gravis should be considered. Occasionally, myasthenia gravis can present with primarily proximal weakness in childhood. A good history, testing for acetylcholine receptor antibodies and electrophysiologic studies with nerve conduction studies (NCS) and electromyography (EMG), including repetitive stimulation, can help to distinguish myasthenia gravis from GBS.

GBS-like syndromes can occur in certain infections, such as Lyme disease or HIV infection. In these cases, lumbar puncture (LP) results typically show a CSF pleocytosis.

Myelopathies also can present sometimes as progressive weakness, and the physical examination should help differentiate a spinal cord syndrome from a diffuse neuropathy. Transverse myelitis can also produce a rapidly progressive paralysis, hyporeflexia, and back pain. Poliomyelitis and other enteroviral infections of the anterior horn cell cause acute focal, asymmetric limb weakness, usually in association with fever and pain.

Other acute neuropathies, caused by lead, heavy metals, or vincristine, can cause a predominantly motor neuropathy. Occasionally, organophosphate poisoning may produce a GBS-like picture.

Tick infestation can cause an ascending paralysis, and children should be searched for ticks if they present with these symptoms. Often, the clinical syndrome improves dramatically after removal of ticks. In the Eastern states of United States, the tick of greatest concern is called Dermacentor variabilis.

The following spinal cord lesions may be considered in the differential diagnosis:

  • Transverse myelitis
  • Epidural abscess
  • Tumors
  • Poliomyelitis
  • Enteroviral infections of the anterior horn cells
  • Hopkins syndrome
  • Vascular malformations
  • Cord infarctions
  • Cord compression
  • Lumbosacral disk syndromes
  • Trauma

Peripheral neuropathies from the following may produce a GBS-like picture:

  • Vincristine
  • Glue sniffing
  • Heavy metals
  • Organophosphate pesticides
  • HIV infection
  • Diphtheria
  • Lyme disease
  • Inborn errors of metabolism
  • Leigh disease
  • Tangier disease
  • Porphyria

Critical illness polyneuropathy

Myopathies that may resemble GBS include periodic paralysis, dermatomyositis, critical illness myopathy, benign acute childhood myositis.[30]

The diagnosis of childhood GBS reportedly can be delayed if respiratory involvement is the primary clinical finding upon presentation. Mistaken suspicion of a respiratory illness may delay the diagnosis of GBS in children.[31]

Go to Guillain-Barre Syndrome and Emergent Management of Guillain-Barre Syndrome for complete information on these topics.

Differential Diagnoses

Contributor Information and Disclosures

Marc P DiFazio, MD Associate Professor, Department of Neurology, Uniformed Services University of the Health Sciences; Director, Pediatric Subspecialty Services, Shady Grove Adventist Hospital for Children

Marc P DiFazio, MD is a member of the following medical societies: Alpha Omega Alpha, International Parkinson and Movement Disorder Society, American Academy of Cerebral Palsy and Developmental Medicine, American Academy of Neurology, Child Neurology Society

Disclosure: Nothing to disclose.


Nitin C Patel, MD, MPH, FAAN Professor of Clinical Pediatrics and Neurology, Southern Illinois University School of Medicine; Private Practice, Columbia Center for Child Neurology

Nitin C Patel, MD, MPH, FAAN is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Headache Society, Child Neurology Society

Disclosure: Nothing to disclose.

Brian S Tseng, MD, PhD Assistant Professor, Department of Neurology, Division of Pediatric Neurology, Harvard Medical School, Massachusetts General Hospital

Brian S Tseng, MD, PhD is a member of the following medical societies: Child Neurology Society

Disclosure: Nothing to disclose.

Sameer Chhibber, MD, FRCPC Neuromuscular Fellow, Department of Neurology, Brigham and Women's Hospital and Massachusetts General Hospital, Harvard Medical School

Disclosure: Nothing to disclose.

Mita N Patel University of Missouri-Columbia School of Medicine

Disclosure: Nothing to disclose.

Chief Editor

Amy Kao, MD Attending Neurologist, Children's National Medical Center

Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, Child Neurology Society

Disclosure: Have stock from Cellectar Biosciences; have stock from Varian medical systems; have stock from Express Scripts.


Neil A Busis, MD Chief, Division of Neurology, Department of Medicine, Head, Clinical Neurophysiology Laboratory, University of Pittsburgh Medical Center-Shadyside

Neil A Busis, MD is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Jennifer A Markowitz, MD Attending Physician, Department of Neurology, Children's Hospital Boston

Jennifer A Markowitz, MD is a member of the following medical societies: Child Neurology Society

Disclosure: Nothing to disclose.

Robert Stanley Rust Jr, MD, MA Thomas E Worrell Jr Professor of Epileptology and Neurology, Co-Director of FE Dreifuss Child Neurology and Epilepsy Clinics, Director, Child Neurology, University of Virginia School of Medicine; Chair-Elect, Child Neurology Section, American Academy of Neurology

Robert Stanley Rust Jr, MD, MA is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Headache Society, American Neurological Association, Child Neurology Society, International Child Neurology Association, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Sarah Sheikh, MBBCh, MSc, MRCP Neuromuscular Fellow, Department of Neurology, Brigham and Women's Hospital

Sarah Sheikh, MBBCh, MSc, MRCP is a member of the following medical societies: American Academy of Neurology, Massachusetts Medical Society, and Royal College of Physicians of the UK

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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