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Diagnosis, assessment, and management of Guillain–Barré syndrome 

Diagnosis, assessment, and management of Guillain–Barré syndrome
Diagnosis, assessment, and management of Guillain–Barré syndrome

David Brealey

and Nicholas Hirsch

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date: 26 May 2022

The Guillain–Barré Syndrome describes a spectrum of acute inflammatory polyneuropathies and is the commonest cause of acute flaccid paralysis within the western world. The pathophysiology is complex and poorly understood, but appears to be an immune-mediated destruction of either the myelin sheath and/or the axons, predominantly of motor nerves. The clinical presentation is classically a rapid, ascending, flaccid paralysis, with minimal sensory deficit. This may ascend to involve respiratory or bulbar muscle function. These patients need careful monitoring and, if deteriorating, should be electively intubated and ventilated. Autonomic instability and sensory disturbance, including pain, is common. Treatment of the underlying condition relies upon immunomodulation with either intravenous immunoglobulin or plasma exchange. Supportive care is aimed at maintaining a safe airway, ventilatory support, and managing the complications of autonomic dysfunction and prolonged immobility. Mortality rates range up to 20%, but are significantly better in specialist neuromedical units. Survivors are often left with significant disability.

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