Diagnostic Considerations

Diagnostic criteria for Guillain–Barré syndrome (GBS) was developed by the National Institute of Neurological Disorders and Stroke (NINDS) and subsequently modified in a review paper.^{[24, 25, 23]}

Required features for diagnosis

See the list below:

Progressive bilateral arms and leg weakness (only legs may initially be involved)
Absent or decreased tendon reflexes in affected limbs (at some point in clinical course)

Supportive features for diagnosis

See the list below:

Progressive course (days to 4 weeks)
Relatively symmetric symptoms and signs
Fairly mild sensory symptoms and signs
Cranial nerve involvement, especially bilateral facial palsy
Autonomic dysfunction
Muscular or radicular back or limb pain
Increased protein level in cerebrospinal fluid (CSF); normal protein levels do not rule out the diagnosis
Electrodiagnostic features of motor or sensorimotor neuropathy (normal electrophysiology in the early stages does not rule out the diagnosis)

Features casting doubt on diagnosis

See the list below:

Increased numbers of mononuclear or polymorphonuclear cells in CSF (> 50 cells/µL)
Marked, persistent asymmetry of weakness
Bladder or bowel dysfunction at onset or persistent during disease course
Severe respiratory dysfunction with limited limb weakness at onset
Sensory signs with limited weakness at onset
Fever at onset
Nadir < 24 h
Sharp sensory level indicating spinal cord injury
Hyper-reflexia or clonus
Extensor plantar responses
Abdominal pain
Slow progression with limited weakness without respiratory involvement
Continued progression for > 4 weeks after start of symptoms
Alteration of consciousness (except in Bickerstaff brainstem encephalitis)

Features that rule out diagnosis

See the list below:

History of hexacarbon abuse
Acute intermittent porphyria
Recent diphtheritic infection
Poliomyelitis, botulism, toxic neuropathy, functional paralysis

Comparison of clinical features of Guillain-Barré syndrome with CIDP

See the list below:

Patients with chronic inflammatory demyelinating polyneuropathy (CIDP) have a more slowly progressive weakness over months (at least > 2 months) and a protracted course either monophasic or relapsing, and relapses are much more common with CIDP. While a history of viral infection is often obtained with Guillain-Barré syndrome, this is rather uncommon in CIDP. Occurrence of respiratory failure is very uncommon with CIDP. Both conditions are associated with areflexia, typical CSF findings of increased protein, abnormal nerve conduction studies (patchy conduction slowing with Guillain-Barré syndrome and diffuse slowing with CIDP). While prednisone therapy on its own has no proven role in Guillain-Barré syndrome, CIDP patients are sensitive to prednisone therapy.
Guillain-Barré syndrome and CIDP have been associated with HIV-1 infection. They are most common in infected patients who are otherwise asymptomatic. In certain cases, Guillain-Barré syndrome may occur with seroconversion. The clinical features of Guillain-Barré syndrome and CIDP in HIV-1 infected patients are similar to patients without HIV-1 infection.

Differential Diagnoses

Workup

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Author

Emad R Noor, MBChB Assistant Professor of Neurology and Clinical Neurophysiology, Hackensack Meridian School of Medicine; Attending Neurologist/Clinical Neurophysiologist, Neuroscience Institute at JFK Medical Center

Emad R Noor, MBChB is a member of the following medical societies: American Academy of Neurology, American Medical Association, Egyptian Society of Neurology, Psychiatry, and Neurosurgery

Disclosure: Nothing to disclose.

Coauthor(s)

Mahsa Mohajery, MD Chief Resident Physician, Department of Neurology, JFK University Medical Center, Hackensack Meridian School of Medicine

Mahsa Mohajery, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, Iranian American Medical Association, Medical Council of Islamic Republic of Iran

Disclosure: Nothing to disclose.

Hasnain Arshad, MD Resident Physician, Department of Neurology, JFK University Medical Center, Hackensack Meridian School of Medicine

Hasnain Arshad, MD is a member of the following medical societies: Pakistan Medical and Dental Council

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Glenn Lopate, MD Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University in St Louis School of Medicine; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD, CPE, MHCM, FAAPL Co-Founder and Former Chief Publishing Officer, eMedicine and eMedicine Health, Founding Editor-in-Chief, eMedicine Neurology; Founder and Former Chairman and CEO, Pearlsreview; Founder and CEO/CMO, PHLT Consultants; Former Chief Medical Officer, MeMD Inc

Nicholas Lorenzo, MD, CPE, MHCM, FAAPL is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association for Physician Leadership

Disclosure: Nothing to disclose.

Additional Contributors

Richard A Sater, MD, PhD Neurologist, High Point Neurology Associates

Richard A Sater, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Medical Association, American Society of Neuroradiology

Disclosure: Nothing to disclose.

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS † Professor Emeritus of Neurology and Psychiatry, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Neuroscience Director, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners Institute, American College of International Physicians, American College of Physicians, American Heart Association, American Stroke Association, National Association of Managed Care Physicians, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, Royal Society of Medicine

Disclosure: Nothing to disclose.