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:
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Transverse myelitis
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Epidural abscess
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Tumors
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Poliomyelitis
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Enteroviral infections of the anterior horn cells
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Hopkins syndrome
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Vascular malformations
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Cord infarctions
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Cord compression
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Lumbosacral disk syndromes
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Trauma
Peripheral neuropathies from the following may produce a GBS-like picture:
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Vincristine
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Glue sniffing
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Heavy metals
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Organophosphate pesticides
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HIV infection
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Diphtheria
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Lyme disease
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Inborn errors of metabolism
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Leigh disease
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Tangier disease
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Porphyria
Critical illness polyneuropathy
Myopathies that may resemble GBS include periodic paralysis, dermatomyositis, critical illness myopathy, benign acute childhood myositis. [33]
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. [34]
Go to Guillain-Barre Syndrome and Emergent Management of Guillain-Barre Syndrome for complete information on these topics.
Differential Diagnoses
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Lyme Disease
