Guillain-Barre Syndrome is a rare disease in which the body’s immune system attacks its own nerves. This causes weakness, muscle paralysis, and can result in respiratory failure in some cases.
Respiratory therapists are required to learn about this disorder in order to treat and help care for these types of patients. This guide will help you learn the basics, and it has practice questions on this topic as well. So, if you’re ready, let’s get into it.
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What is Guillain-Barre Syndrome?
Guillain-Barre Syndrome (GBS) is a rapid-onset disease in which the patient’s autoimmune system attacks and causes inflammation and deterioration of the peripheral nervous system.
The condition causes an ascending paralysis, which means that it originates in the feet and ascends upward throughout the rest of the body.
Signs and Symptoms
Patients with Guillain-Barre Syndrome may experience the following signs and symptoms:
- Tingling of the toes and feet
- Shallow breathing
- Lower back pain
- Difficulty swallowing
- Loss of bladder control
Each patient may show some or all of these signs and symptoms, depending on the severity of their condition.
Patients with Guillain-Barre Syndrome may require the following treatment methods:
- Intubation and mechanical ventilation
- Intravenous immunoglobulins
- Pain medication
- Pulmonary hygiene therapy
- Hyperinflation therapy
- Cardiopulmonary rehabilitation
The treatment methods may vary depending on the signs and symptoms of each individual patient.
Guillain-Barre Syndrome Practice Questions:
1. What is Guillain-Barre Syndrome?
It’s an acute, rapidly progressing polyneuritis that causes ascending symmetrical paralysis. In other words, it’s a rare autoimmune disorder of the peripheral nervous system (PNS) in which the flaccid paralysis of the skeletal muscle and loss of reflexes develop, usually in a person that was previously healthy.
2. What does Guillain-Barre affect?
If effects cranial nerves and the peripheral nervous system.
3. What causes Guillain-Barre?
An autoimmune (viral infection, trauma, surgery, or viral immunization) that leads to demyelination, edema and inflammation.
4. What are the clinical manifestations of Guillain-Barre?
Weakness, paresthesia, paralysis, hypotonia, areflexia, ANS dysfunction, pain, SIADH (syndrome of inappropriate antidiuretic hormone secretion), and respiratory failure.
5. What investigation is done to diagnose Guillain-Barre?
History, physical exam, CSF analysis, EMG, nerve conduction tests and brain MRI.
6. What care should be done for patients with Guillain-Barre?
Mechanical ventilation, plasmapheresis, IV immunoglobulins, vasopressors
7. What can occur in severe cases of Guillain-Barre?
Paralysis of the diaphragm and ventilatory failure.
8. What can develop from Guillain-Barre?
Mucous accumulation, airway obstruction, and atelectasis.
9. What happens to the myelin sheath due to Guillain-Barre?
Demyelination and inflammation can occur.
10. What causes paralysis in Guillain-Barre?
It prevents the ability of the neurons to transmit impulses to the muscles.
11. How does Guillain-Barre spread?
From the ground to the brain, it starts at the extremities and works towards the head. It’s an ascending disorder.
12. What is the precise cause of Guillain-Barre?
The precise cause is unknown.
13. What antigen causes the infections in Guillain-Barre?
14. What elevated levels are present in Guillain-Barre?
Antiganglioside antibodies and protein levels (also normal/decreased WBC).
15. What factors are more susceptible to Guillain-Barre?
Being Caucasian (50 to 60% more likely) and being >45 years of age.
16. What is the clinical presentation of Guillain-Barre?
Symmetric Muscle Weakness with tingling, burning, shock-like sensations; throbbing pain; numbness to extremities, face, and trunk can occur; drooling and difficulty swallowing; and, respiratory muscle paralysis.
17. What percent of people with Guillain-Barre make a full recovery?
90% (10% have long-term neurological deficits).
18. How long is the recovery time for Guillain-Barre?
6 months to two years but not much recovery after 2 years and may be as long as 3 years.
19. What history do patients of Guillain-Barre have?
Sudden onset of weakness, abnormal sensations that affect both sides of the body and loss of reflexes, such as knee-jerk.
20. What are the clinical Indicators of ventilatory failure?
FVC: <20 ml/kg; MIP: < -30 cmH2O; NIF: < -20; MEP: <40 mmHg; Ph: < 7.35; and, CO2: > 45 mmHg.
22. What is found not to be effective in treating Guillain-Barre?
Corticosteroids are found not to be effective in treating Guillain-Barre.
23. What breath sounds do patients of Guillain-Barre have?
24. What are the vital signs for Guillain-Barre patients?
Heart rate is increased, respiratory is increased, and oxygen saturation is decreased.
25. What will the chest x-ray for Guillain-Barre patient look like?
It will appear normal or slight decrease in
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26. What will be seen on chest percussion for a Guillain-Barre patient?
It will be normal.
27. What will be the ABG of a Guillain-Barre patient?
Uncompensated acute respiratory acidosis.
28. What are the Guillain-Barre Diagnostic tests?
Spinal tap, electromyography
29. What type of airway disease is Guillain-Barre?
30. What type of disease is Guillain-Barre?
31. What is the other name of Guillain-Barre Syndrome?
Acute inflammatory demyelinating polyradiculoneuropathy.
32. What type of disorder is Guillain-Barre Syndrome?
33. What are the other causes of Guillain-Barre Syndrome?
Viral, bacterial infection, surgery, or vaccinations.
34. What will develop in the 2/3 of patients within 2 months of contracting Guillain-Barre Syndrome?
35. What conditions will 90% of Guillain-Barre Syndrome patients have within one month of the disease?
GI or URI.
36. How do lesions with Guillain-Barre Syndrome happen?
Throughout the whole PNS.
37. From where do lesions occur?
Spinal roots to distal termination of
38. What is the primary target of Guillain-Barre Syndrome?
39. How does demyelination occur with Guillain-Barre Syndrome?
There is a generalized inflammatory response and myelin is stripped from the nerves.
40. When does classic acute Guillain-Barre Syndrome peaks?
At 4 weeks.
41. How do motor deficits, sensory deficits, and weakness present with the classic acute form?
Rapidly ascending symmetrically distally.
42. What kind of recovery do Guillain-Barre patients have?
Often complete or near complete.
43. Why does Guillain-Barre Syndrome have flaccid paralysis?
It is LMN.
44. How long does recovery take?
Month to years.
45. What condition of patients that may result in a poorer recovery?
The older patient, late initiation of treatment and with axonal degeneration.
46. What is very important to do with patients with Guillain-Barre?
Positioning, bed mobility, ROM, and plasmapheresis.
47. What residual effects with Guillain-Barre most likely to be?
48. What are the signs and symptoms of Guillain-Barre Syndrome?
Tingling of UE and
49. What are the risk factors for Guillain-Barre Syndrome?
Epstein Barr virus, HIV, and mycoplasma pneumonia.
50. What is the pathophysiology of Guillain-Barre Syndrome?
Damage to myelin, muscle paralysis, sensory disturbance, and autonomic dysfunction. Acute inflammatory demyelinating polyradiculoneuropathy characterized by areflexia. Flaccid paralysis affects limb movement, facial muscles, dysphagia, dysarthria, and respiration. Neurologic dysfunction includes a
51. What are the types of Guillain-Barre Syndrome?
Acute inflammatory demyelinating polyradiculoneuropathy in
52. What is the prognosis of Guillain-Barre Syndrome?
The distal compound motor action potential (CMAP) is a predictor of prognosis. If the CMAP amplitude is less than 20% of normal limits at 3-5 weeks, it predicts a prolonged or poor outcome. 3%-5% die from systemic organ failure. Most common long-term effects are a weakness of pretibial muscles and less often in hands, feet, and quadriceps and gluteal muscles. Most of the recovery is during the first year with
53. What are the treatments for Guillain-Barre Syndrome?
Plasmapheresis, intravenous immunoglobulins, intubation, and glucocorticoids.
54. What is the etiology of GBS?
Evidence supports that it is an immune-mediated disorder. Causative factors are, Bacterial:
55. What is the onset of GBS?
No identified illness (~27%), 2/3 had symptoms of an infectious disease two weeks before onset of GBS symptoms, of 2/3 patients reporting
56. What is required for the diagnosis of GBS?
Progressive weakness on more than one extremity (symmetrical presentation) and areflexia.
57. What symptoms are supportive of diagnosis in order of importance?
Weakness developing rapidly that ceases to progress by week four, symmetric weakness, mild sensory,
CSF protein (albumin) levels increased after 1 week; continue to increase on serial examinations, and, CSF contains 10 or fewer mononuclear leukocytes/mm3.
59. What are the comorbidities of Guillain-Barre?
60. What are the complications of Guillain-Barre?
Pressure sores, wounds, contractures, DVT / pulmonary embolism, HTN, sinus tachycardia, cardiac dysrhythmia, bladder dysfunction, G.I. motility disorder (PEG tube), depression and pneumonia.
61. What type of disease is Guillain-Barre classified as?
Acute polyneuropathy and peripheral nervous system disease.
62. How does Guillain-Barre start?
It is often preceded by an event such as a mild respiratory or GI infection, viral or bacterial infection or surgical procedure.
63. What types of bacterial and viral infection are associated with Guillain-Barre?
Cytomegalovirus (herpes), Epstein-Barr (mono) and HIV.
64. What is the overall difference when treating Guillain-Barre patients versus MS patients?
The GBS patients will be getting better so we need to plan accordingly and minimize any type of compensations or adaptations. For MS patients as they get worse we may teach them adaptations and compensations.
65. What are the symptoms of Guillain-Barre?
Paresthesia, LE weakness, sensation deficits, respiratory problems and autonomic abnormalities.
66. What is the pathology of Guillain-Barre?
Lymphocytic infiltrates deposited on the surfaces of the myelinated fibers, leads to degeneration of myelin. Later axonal involvement and Wallerian degeneration
67. What is a difference in MS that we see with Guillain-Barre?
We see Schwann cell proliferation and axonal regrowth in GBS.
68. How is Guillain-Barre diagnosed?
CSF protein and nerve conduction velocities.
69. What is the sensory pattern for Guillain-Barre?
Tocking and glove pattern.
70. What is some common sensory impairment for Guillain-Barre?
Paraesthesia and proprioception.
71. What type of motor weakness do we see with Guillain-Barre?
Ascending paralysis (starts distally).
72. What parts of the body are affected last with motor weakness in patients of Guillain-Barre?
Trunk, intercostal, cranial nerves, face, and respiratory system.
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73. What type of autonomic dysfunctions do we see with Guillain-Barre?
Fluctuating BP, decreased cardiac output and bradycardia.
74. What are the medical treatments for Guillain-Barre?
Plasma exchange and immunoglobulin therapy.
75. What important things need to be noted about the history of Guillain-Barre?
The onset and pattern of symptoms as this provides significant information if they are getting worse or recovering and guides therapy.
76. How do you test MMT with patients of Guillain-Barre?
Specific and regularly (1x week) to monitor improvement.
77. Why is ROM an important aspect of Guillain-Barre therapy?
The patients are expected to fully recover so maintaining ROM is an important aspect in order that it does not hinder recovery.
78. What is an important aspect of gait training for patients with Guillain-Barre?
Avoid compensations. May use
79. Why are reflexes particularly useful for the patients with Guillain-Barre?
It can give an indication of what is going on with innervation of the muscle.
80. What needs to be avoided when strengthening patients who have Guillain-Barre?
Working them to fatigue.
Guillain-Barre Syndrome is a rare but important disorder that every respiratory therapist must be familiar with. The reason is because it often leads to respiratory failure, which may require treatment with mechanical ventilation.
Hopefully, this guide can help make the learning process easier for you.
If you enjoyed this information, we have a similar guide on myasthenia gravis that I think you’ll find helpful. Thanks for reading and, as always, breathe easy, my friend.
John Landry, BS, RRT
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
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- “Diagnosis and Management of Guillain–Barré Syndrome in Ten Steps.” PubMed Central (PMC), 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6821638.
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