Diagnosis of

Guillain Barre Syndrome

PBL 29 Tattered Nerve

Differential Diagnosis

Diphtheria
Lyme disease
Neuromuscular transmission disorder
Botulism
Snake venom
Brainstem infarction
Acute myelopathies
Transverse myelitis

 Take note of the preconditions particularly

early in the course
Ask the patient whether he travelled to any
regions (tropical regions, poisonous to be
considered, underdeveloped countries)
Ask the patient regarding their detailed daily
activities (recently)
Detailed history and careful examination can
come up with correct initial diagnosis GBS

Evaluation of GBS

Electrodiagnostic testing
Testing of nerves and muscles
Can provide an estimate of prognosis
Can be done in emergency room or even ICU
and the results can be obtained after
completing the test
May be painful but relatively non-invasive
Involving electromyography (EMG) and nerve
conduction study

Nerve Conduction Studies

Most important
Electric shock (given using small, hand held
device) through skin at different sites along
the course of the nerves (2 sites) to activate
the nerves
Responses are recorded with small
needles/small disc inserted
The electrical impulse travels along the nerve
can be recorded from the muscles it supply

Size of response reflects the number of functioning nerves connected to muscle fibers,
speed of conduction reflects the integrity of myelin sheath . (Normal electrical
impulses travel at 40 to 45 m/s)

Motor conduction study on the hand of 37 years old man who has been weak for GBS
for 8 days

Electromyography
Plays a negligible role but is an important supplementary
tool to assess degree of axonal damage
A needle is inserted into the muscle to sense the electrical
activity
Needle is inserted onto a relaxed muscle initially and ask
the patient to contract the muscle, the muscle activity will
be transform into visual and aural signal
Abnormal if electrical activity in relaxed muscle (fibrillation)
Not shown onset, people suspected of having GBS will be
asked to return for second study a few weeks after initial
study
Degree of prognosis is depending on degree of fibrillation

Cerebrospinal fluid testing

Done by lumbar puncture, where a fine needle is
inserted between L4/L5 spinal cord segment and
withdrawn the cerebrospinal fluid
Increase in level of protein concentration with
normal numbers of cells (albuminocytologic
dissociation), normal level of glucose, lymphocyte
cell count <50cells/ml
Second tap is needed after a week or so if patient
is suspected of having GBS

Blood test
White blood cell count usually normal, no
antibodies against nerve components can be
reliably detected in blood
Is done to exclude other conditions/establish
nature of any antecedent infection that has
lead to GBS
Antibodies against the microorganisms can be
detected
Monitor level of sodium concentration

X-Ray/MRI Scans
Not typically necessary
May be useful if there are unusual feature that
makes the diagnosis uncertain
Eg. Inflammation of spinal cord in transverse
myelitis mimics GBS
MRI of brain will be done if there is prominent
involvement of cranial nerves (in Miller Fisher
Syndrome)