Guillain-Barré Syndrome: Emergency Warning Signs Requiring Immediate Care

Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy. Rapid progression can cause respiratory failure and autonomic instability—both life-threatening.

Emergency Red Flags (Call 911 / Go to ER)

• Respiratory: Dyspnoea at rest, inability to lie flat, vital capacity <20 mL/kg, MIP < -30 cmH₂O, SpO₂ <92%.
• Bulbar: Dysphagia (choking risk), dysarthria, facial weakness, inability to protect airway.
• Autonomic: Labile BP (hypertensive crisis → hypotension), arrhythmias, cardiac arrest, ileus, urinary retention.
• Motor: Rapidly ascending weakness (legs → arms → face/respiratory), inability to stand/walk.
• Cranial nerves: Ophthalmoplegia, ptosis, pupillary abnormalities (Miller Fisher variant).
• Pain: Severe neuropathic/back pain.

Diagnostic Urgency

• Lumbar puncture: Albuminocytologic dissociation (↑ protein, normal WBC) — peaks week 2.
• NCS/EMG: Demyelinating (AIDP) vs. axonal (AMAN/AMSAN) patterns.
• Anti-ganglioside antibodies (GM1, GD1a, GQ1b).

Time-Sensitive Treatments

• IVIG: 2 g/kg over 5 days (standard).
• Plasma exchange (PLEX): 5 exchanges over 7–10 days.
• Equally effective; IVIG more convenient. Start within 2–4 weeks of onset.
• ICU monitoring for respiratory/autonomic instability.

Prognosis

• 80% walk independently at 6 months.
• 5–10% residual severe disability.
• 3–7% mortality (despite treatment).
• Relapse → CIDP or treatment-related fluctuation.

GBS is a neurological emergency. Early immunotherapy and respiratory support save lives. Do not wait for "complete" workup if red flags present.