Clinical Features of Guillain-Barré Syndrome

Abstract

Guillain-Barré syndrome usually occurs after a preceding infection and begins with a combination of pain, sensory symptoms and weakness. The pain is usually a diffuse aching in the back, neck or limbs: it occurred in half of a series of 100 patients (Winer et al. 1988). It may be a prominent feature. Occasionally in children pain may cause meningism and rarely retrocollis. It is sometimes difficult to distinguish between the subsiding pain of the previous influenza like illness and the pain which accompanies the start of the neuropathic process. By definition weakness develops in all patients. It is usually first noted in the lower limbs as difficulty rising from a chair, climbing stairs, walking and standing. The upper limbs are often affected as well, usually less severely. Occasionally weakness is much more severe in or even confined to the lower limbs. Even more rarely weakness is more severe in the upper limbs. The weakness is usually proximal and distal and often more pronounced proximally than distally. It is usually approximately symmetrical but may be quite markedly asymmetrical especially at the onset. Loss of feeling and tingling in the extremities are characteristic early symptoms occurring in nearly 80% of patients (Winer and Hughes 1988). Sensory complaints are usually minor and little sensory deficit is discovered on conventional neurological examination although some patients have profound sensory loss and half lose joint position sense at the toes. The tendon reflexes are usually lost or at least diminished from an early stage and this is a required diagnostic criterion.