Guillain-Barré syndrome: a team approach to diagnosis and treatment.

Guillain-Barré syndrome is the most frequently acquired demyelinating peripheral polyneuropathy. In approximately two-thirds of cases, Guillain-Barré syndrome is preceded by a viral respiratory or gastrointestinal infection. The mechanism of injury is unclear but is believed to be immunologic. The cardinal clinical feature is symmetric and rapidly progressive weakness. Aspiration and respiratory failure are the major concerns. Sensory symptoms, such as paresthesias, are common. The most severe stage of the disease is reached two to four weeks after onset. Dysautonomia has replaced respiratory failure as the most common cause of death. Recovery is variable: 50 percent of patients recover completely, about 35 percent experience permanent neurologic sequelae, and 15 percent are significantly and permanently damaged. About 10 percent relapse before complete recovery, and 2 to 5 percent experience recurrence after full recovery. Laboratory confirmation of Guillain-Barré syndrome includes the typical cerebrospinal fluid cytoalbumin dissociation (elevated protein without white blood cells). Treatment is primarily symptomatic and preventive. Convalescent patients require intensive inpatient physical and occupational therapy to improve strength and prevent disabling contractures.