Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets (hemodynamic, neurologic, respiratory) and reassess frequently.
- Plan definitive source control or disease‑specific therapy when indicated; document follow‑up and patient education.
Algorithm
- Diagnose GBS clinically; obtain LP and NCS/EMG when feasible without delaying care.
- Monitor FVC/NIF serially; admit to ICU if thresholds reached or rapidly progressive.
- Start IVIG or PLEX (do not combine sequentially routinely); begin DVT prophylaxis and PT/OT.
- Manage dysautonomia (arrhythmias/BP swings); avoid steroids; plan rehab and follow‑up.
Clinical Synopsis & Reasoning
Progressive symmetric weakness with areflexia after infection; monitor FVC/NIF for impending respiratory failure. Treat with IVIG or plasma exchange (equivalent efficacy) and manage pain and dysautonomia; avoid steroids.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced/procedural interventions based on explicit failure criteria. Define ICU, step‑down, and ward disposition triggers; involve specialty teams early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitants; see citations for condition‑specific data.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| Lumbar puncture | Supportive | Albuminocytologic dissociation (high protein, normal cells) | May be normal early |
| Nerve conduction studies/EMG | Confirmation | Demyelinating features | Helps subtype |
| Respiratory mechanics (FVC, NIF) | Safety | FVC <20 mL/kg or NIF <−30 cm H2O → ICU/intubation | Serial checks |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| IVIG 2 g/kg over 2–5 days | Immunotherapy | Days | First‑line | Watch for thrombosis/renal issues |
| Plasma exchange (5 exchanges over 1–2 weeks) | Immunotherapy | Days | Equivalent to IVIG | Access/hypotension risk |
| Gabapentin/pregabalin or opioids (selected) | Analgesia | Hours | Neuropathic pain | Sedation |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy; monitor for complications.
Patient Education / Counseling
- Provide red‑flag education, adherence guidance, and explicit return precautions; arrange timely specialty follow‑up.
References
- AAN Practice Parameter and Cochrane Reviews on GBS treatment and monitoring — Link