neurologic disorders
Guillain Barré Syndrome (GBS)
Symptoms and Signs of GBS
Flaccid weakness predominates in most patients with Guillain-Barré syndrome; it is always more prominent than sensory abnormalities and may be most prominent proximally. Relatively symmetric weakness with paresthesias usually begins in the legs and progresses to the arms, but it occasionally begins in the arms or head. In 90% of patients, weakness is usually maximal at 3 to 4 weeks. Deep tendon reflexes are lost. Sphincters are usually spared. Weakness remains the same for a variable period of time, typically for a few weeks, then resolves. Facial and oropharyngeal muscles are weak in > 50% of patients with severe disease. Dehydration and undernutrition may result. Respiratory paralysis severe enough to require endotracheal intubation and mechanical ventilation occurs in 5 to 10%. A few patients (possibly with a variant form) have significant, life-threatening autonomic dysfunction causing blood pressure fluctuations, inappropriate antidiuretic hormone secretion, cardiac arrhythmias, gastrointestinal stasis, urinary retention, and pupillary changes. An unusual variant (Fisher variant, or Miller-Fisher syndrome) may cause only ophthalmoparesis, ataxia, and areflexia. 