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Neurology
Mental Retardation

Approach To The Patient

Approach to the patient

History

The typical GBS patient (likely ATDP) presents 2-4 weeks after a relatively benign respiratory or gastrointestinal illness complaining of dysaesthesias of the fingers and lower extremity proximal muscle weakness. The weakness may progress over hours to days to involve the arms, truncal muscles, cranial nerves, and the muscles of respiration. The illness progresses from days to weeks, with the mean time to the nadir of clinical function being 2-4 weeks. A plateau phase of persistent, unchanging symptoms then ensues followed days later by gradual symptom improvement. The mean time to improvement and clinical recovery are 28 and 200 days, respectively. Up to one third of patients require mechanical ventilation during the course of their illness. Causes for this include cranial nerve involvement affecting airway maintenance and respiratory muscle paralysis. Motor dysfunction
  • Symmetric limb weakness typically begins as proximal lower extremity weakness and ascends to involve the upper extremities, truncal muscles, and the head.
  • Inability to stand or walk despite reasonable strength, especially when ophthalmoparesis or impaired proprioception is present.
  • Respiratory muscle weakness with shortness of breath may be present.
  • Cranial nerve palsies (III-VII, IX-XII) may be present. Patients may present with facial weakness mimicking Bell's palsy, dysphagia, dysarthria, ophthalmoplegia, and pupillary disturbances. The Miller-Fisher variant is unique in that this subtype begins with cranial nerve deficits.
  • Lack of deep tendon reflexes is a hallmark sign.
Sensory dysfunction
  • Paraesthesia generally begins in the toes and fingertips and progresses upward but generally not extending beyond the wrists or ankles.
  • Pain is most severe in the shoulder girdle, back, buttocks, and thighs and may occur with even the slightest movements.
  • Loss of vibration, proprioception, touch, and pain distally may be present.
Autonomic dysfunction
  • Cardiovascular signs may include tachycardia, bradycardia, dysrhythmias, wide fluctuations in blood pressure, and postural hypotension.
  • Urinary retention due to urinary sphincter disturbances may be noted.
  • Constipation due to bowel paresis and gastric dysmotility may be present.
  • Facial flushing and venous pooling secondary to abnormal vasomotor tone may be present.
  • Hypersalivation
  • Anhydrosis
  • Tonic pupils
  • Papilloedema secondary to elevated intracranial pressure is present in rare cases.
Examination
Approach To The Patient

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