Neuroscience · Year 2 · from Neuroscience
Case 2: Guillain-Barre Syndrome
Patient Presentation
Demographics: 35-year-old female
Chief Complaint: Progressive weakness and tingling in legs for 4 days
History of Present Illness: A 35-year-old woman presents with ascending weakness that began with tingling in her feet 5 days ago, following an episode of gastroenteritis 2 weeks prior. The weakness started in her legs and has now progressed to involve her arms. She has difficulty climbing stairs and rising from a chair. Today she noticed weakness in her hands and numbness around her mouth. She denies neck stiffness, fever, or urinary symptoms.
Physical Examination:
- Vital signs: BP 145/92, HR 105, RR 18, negative inspiratory force (NIF) -35 cmH2O (concerning)
- General: Anxious, speaking in short sentences
- Neurological:
- Mental status: Alert, oriented
- Cranial nerves: Bifacial weakness; intact eye movements; weak palate elevation
- Motor: Symmetric weakness: 3/5 hip flexors, 4/5 knee extension, 2/5 ankle dorsiflexion; 4/5 shoulder abduction, 3/5 grip strength
- Tone: Flaccid throughout
- Reflexes: Absent (areflexia) in all extremities
- Sensory: Reduced vibration sense at ankles; mild length-dependent sensory loss
- Gait: Unable to walk without assistance
Workup:
- Lumbar puncture: Albuminocytologic dissociation - elevated protein 185 mg/dL with 3 WBC (normal cell count)
- Nerve conduction studies: Prolonged distal latencies; slowed conduction velocities; conduction block in multiple nerves - consistent with acute inflammatory demyelinating polyneuropathy (AIDP)
- Stool culture: Positive for Campylobacter jejuni
- Anti-ganglioside antibodies: Anti-GM1 positive
- Respiratory monitoring: Serial NIF and FVC performed q4h
Diagnosis: Guillain-Barre syndrome (AIDP variant), post-Campylobacter infection
Treatment:
- ICU admission for respiratory monitoring
- IV immunoglobulin (IVIG) 0.4 g/kg daily for 5 days
- Intubation on day 3 when NIF declined to -20 cmH2O
- DVT prophylaxis
- Physical therapy for contracture prevention
- Autonomic monitoring (blood pressure and heart rate variability)
- Gradual weaning from ventilator after 2 weeks
- Inpatient rehabilitation for 6 weeks; walking independently at 3 months
Clinical Pearl: Guillain-Barre syndrome (GBS) is an acute inflammatory polyneuropathy typically following infection (Campylobacter, CMV, EBV) by 1-4 weeks. The molecular mimicry hypothesis explains pathogenesis: antibodies against microbial antigens cross-react with gangliosides on peripheral nerves. The classic presentation is ascending, symmetric weakness with areflexia (LMN pattern only, unlike ALS). CSF shows the characteristic "albuminocytologic dissociation" (high protein, normal cells). Respiratory failure occurs in 30% of patients, making serial respiratory monitoring essential. Treatment with IVIG or plasmapheresis shortens disease course.