Clinical Features

The symptoms and signs of GBS typically, but not invariably, move proximally.

Diagnostic features

• Progressive weakness in both arms and legs, often starting with legs
• Reduced, or absent, tendon reflexes
• Relative symmetry of symptoms
• Progression of symptoms up to four weeks
• Followed by recovery in about 67% of patients
• Absence of fever at presentation
• Mild sensory symptoms or signs
• Facial weakness or other cranial nerve involvement
• Pain

Precipitants

The most common presentation is a post-infectious disorder in an otherwise healthy patient. Approximately two-thirds of patients report symptoms of an infection (gastrointestinal or upper respiratory) in the preceding three weeks.

Organisms implicated in preceding infections include:

Bacteria

• Campylobacter jejuni
• Haemophilus influenzae
• Mycoplasma pneumoniae

Viruses

• Cytomegalovirus
• Epstein-Barr virus

Early symptoms

Early symptoms are pain, numbness, weakness or paraesthesia in the limbs, followed by a rapidly progressive symmetrical bilateral weakness.

This may extend to respiratory muscles or those innervated by cranial nerves.

Whilst the typical pattern of ascending weakness is well described, the weakness may affect arms and/or legs, and may take on a variety of patterns.

There are generally decreased or absent tendon reflexes in affected limbs.

Labratory findings

Albuminocytological dissociation on CSF analysis after a week of symptom onset is seen in about 66% of patients. This is characterised by raised Cerebrospinal fluid (CSF) protein (>0.4 g/L), with normal white cell count (WCC).

Progression of GBS

The weakness will reach its maximum within four weeks of onset and, in most cases, does so within two weeks.

There is normally a plateau period of varying length followed by a slow recovery phase of weeks, months or even years.

Disease progression beyond 8 weeks is classified as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).