Dysautonomia in Guillain–Barré Syndrome: Prevalence, Clinical Spectrum, and Outcomes

  • Tia ChakrabortyEmail author
  • Christopher L. Kramer
  • Eelco F. M. Wijdicks
  • Alejandro A. Rabinstein
Original Work



Guillain–Barré syndrome (GBS), when severe, involves the autonomic nervous system; our objective was to assess the spectrum and predictors of dysautonomia, and how it may impact functional outcomes.


A retrospective review of patients admitted to the Mayo Clinic in Rochester, MN between January 1, 2000, and December 31, 2017, with GBS and dysautonomia was performed. Demographics, comorbidities, parameters of dysautonomia, clinical course, GBS disability score, and Erasmus GBS Outcome Score (EGOS) at discharge were recorded.


One hundred eighty seven patients were included with 71 (38%) noted to have at least one manifestation of dysautonomia. There are 72% of patients with a demyelinating form of GBS and 36% of patients with demyelination had dysautonomia. Ileus (42%), hypertension (39%), hypotension (37%), fever (29%), tachycardia or bradycardia (27%), and urinary retention (24%) were the most common features. Quadriparesis, bulbar and neck flexor weakness, and mechanical ventilation were associated with autonomic dysfunction. Patients with dysautonomia more commonly had cardiogenic complications, syndrome of inappropriate antidiuretic hormone, posterior reversible encephalopathy syndrome, and higher GBS disability score and EGOS. Mortality was 6% in patients with dysautonomia versus 2% in the entire cohort (P = 0.02).


Dysautonomia in GBS is a manifestation of more severe involvement of the peripheral nervous system. Accordingly, mortality and functional outcomes are worse. There is a need to investigate if more aggressive treatment is warranted in this category of GBS.


Dysautonomia Guillain–Barré syndrome Acute inflammatory demyelinating polyradiculoneuropathy Autonomic dysfunction 



Guillain–Barré syndrome


Acute demyelinating polyradiculoneuropathy


Intensive care unit


Posterior reversible encephalopathy syndrome


Syndrome of inappropriate antidiuretic hormone


Erasmus GBS Outcome Score


Chronic inflammatory polyradiculoneuropathy


Compound muscle action potential




Cerebrospinal fluid


Intravenous immunoglobulin




Pulmonary embolism


Deep vein thrombus


Interquartile range


Odds ratio


Confidence interval



No other acknowledgements.

Author Contributions

This study required no sponsorship or funding. Tia Chakraborty MD authored, conceptualized, acquired data, performed all statistical analyses, drafted, and revised the manuscript. She had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Christopher Kramer MD analyzed and acquired data, conceptualized, drafted, and revised the manuscript. Eelco Wijdicks MD PhD authored, conceptualized, drafted, and revised the manuscript. Alejandro A. Rabinstein MD authored, conceptualized, drafted, and revised the manuscript.

Source of Support

Not applicable.

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval/Informed Consent

The Mayo Clinic Institutional Review Board approved this study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2019

Authors and Affiliations

  1. 1.Mayo Clinic Department of NeurologyMayo ClinicRochesterUSA
  2. 2.Department of NeurologyThe University of ChicagoChicagoUSA

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