Guillain Barre Syndrome

Aka: Guillain Barre Syndrome, Guillain-Barre Syndrome, Landry-Guillain-Barre Syndrome, Guillain-Barre-Strohl Syndrome, Acute Inflammatory Demyelinating Polyradiculoneuropathy, Acute Motor Axonal Neuropathy, Acute Motor Sensory Axonal Neuropathy, Miller Fisher Syndrome, Bickerstaff Brainstem Encephalitis, Bickerstaff's Brainstem Encephalitis

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II. Definitions

  1. Guillain Barre Syndrome
    1. Acute Progressive, idiopathic immune polyradiculopathy
    2. Symmetrical weakness and loss of Deep Tendon Reflexes reaching maximal intensity within 4 weeks

III. Epidemiology

  1. Incidence
    1. Annual Incidence: 1-3 cases per 100,000
    2. Most common cause of Acute Flaccid Paralysis worldwide (including in children)
      1. Prior to Polio Vaccine, Polio was the most common cause
  2. Age
    1. May occur in any age group
    2. In children, most commonly affects age <5 years
    3. Most common over age 50 years and Incidence increases with advancing age
  3. Gender
    1. Male to female ratio: 3 to 2
    2. Almost all other Autoimmune Conditions are female predominant
      1. GBS is more common in women with Rheumatologic Disorders, Preeclampsia history or prior Blood Transfusions

IV. Background

  1. First identified pulverized myelin in affected patients in 1916 by Guillain, Barre and Strohl

V. Precautions

  1. Presentation may have subtle, non-specific findings early in the course
    1. Patients are initially well appearing
    2. Focal Paresthesias (esp. lower extremity)
    3. Perception of weakness without motor weakness on exam
    4. Deep Tendon Reflexes may initially be preserved, and may appear to be asymmetric
  2. Patients typically do not present with Dyspnea
    1. However, the highest morbidity and mortality is from Hypoventilatory Respiratory Failure
    2. Frequently monitor for significant respiratory weakness with Negative inspiratory pressure (NIF)

VI. Pathophysiology

  1. Inflammatory Neuropathy with cross reactivity between antibodies to infectious agents and neural Antigens
  2. Lipooligosaccharides in Bacterial cell wall resemble gangliosides
  3. Anti-ganglioside antibodies form in response to acute infections (e.g. Diarrhea with Campylobacter jejuni)

VII. Types: Most Common Subtypes

  1. Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP)
    1. Most common subtype in the United States (90-95% of U.S. cases)
    2. Multifocal peripheral demyelination with slow remyelination
      1. Presents with progressive ascending Paresthesias, symmetrical weakness and hyporeflexia
      2. Symptoms start in legs in 90% of cases
      3. Associated back pain is common, while Leg Pain and Headache are uncommon
  2. Acute Motor Axonal Neuropathy (AMAN)
    1. Accounts for 5-10% of Guillain-Barre Syndrome cases in U.S.
      1. However, accounts for 30 to 60% of cases in China, Japan and South America
    2. Anti-ganglioside antibodies (GM1, GD1a, GalNAc-GD1a, GD1b) bind in peripheral Motor Nerve axons
    3. Most associated with Campylobacter jejuni infection (esp. younger patients, summer, China and Japan)
    4. Pure motor Neuropathy
      1. Acute motor weakness is followed by areflexia, Ataxia and oculomotor deficits
      2. Sensory predominant Axonal Neuropathy (AMSCAN, see below) may occur, but is rare
    5. No demyelination (contrast with AIDP)
    6. Nodes of Ranvier predominantly injured

VIII. Types: Uncommon to Rare Subtypes

  1. Miller Fisher Syndrome (3-5% of U.S. cases, but 25% of cases in Asia)
    1. Anti-ganglioside antibodies (GQ1b, GD3, GT1a)
    2. Bilateral Ophthalmoplegia, Ataxia and areflexia (2 of 3 present for diagnosis)
    3. Any Cranial Nerve may be affected, but predisposition to CN3, CN4 and CN6
    4. Facial or bulbar weakness (50% of cases)
    5. Trunk and extremity weakness (50% of cases)
    6. Rare in children
  2. Acute Motor Sensory Axonal Neuropathy (AMSCAN)
    1. Similar to AMAN subtype, but sensory Neuropathy predominates
    2. Pure sensory Axonal Neuropathy is rare
  3. Bickerstaff Brainstem Encephalitis (rare)
    1. Presents with Ataxia, encephalopathy and Ophthalmoplegia
    2. Median age of onset 35 years
    3. Rare in U.S. (more common in Asia)
  4. Descending Motor Weakness (rare)
    1. Motor weakness affects Cranial Nerves first, followed by arm and leg weakness
  5. Acute Panautonomic Neuropathy (rarest)
    1. Autonomic symptoms (cardiovascular and visual)
    2. Sensory loss (may be absent, with pure Autonomic Dysfunction)
    3. Slow, often incomplete recovery

IX. Risk Factors

  1. Idiopathic with no identified inciting event in up to one third of cases
  2. Acute infection
    1. Upper Respiratory Infection or Gastroenteritis (in prior 1 to 6 weeks) precedes GBS in 66-71% of cases
    2. Campylobacter jejuniGastroenteritis (most common)
      1. Guillain-Barre occurs in one in 1000 patient infected with Campylobacter jejuni
      2. C. jejuni Lipooligosaccharides resemble human peripheral membrane gangliosides
        1. Infection triggers autoimmune response against the peripheral membrane
    3. Cytomegalovirus (second most common)
    4. Epstein-Barr Virus (Mononucleosis)
      1. Associated with milder forms of Guillain-Barre
    5. Mycoplasma pneumoniae
    6. Haemophilus Influenzae
    7. HIV Infection
    8. Herpes Simplex Virus
    9. Varicella Zoster Virus
    10. Vector-Borne Infections (Mosquito borne)
      1. West Nile Virus
      2. Zika Virus
  3. Vaccinations are associated with no significant increased risk
    1. H1N1 Influenza Vaccine was associated with a risk of 1-2 cases per 1 Million (esp. 1976 Influenza Vaccine)
      1. De Wals (2012) JAMA 308(2): 175-81 [PubMed]
    2. Covid19 Vaccine (associated with AIDP)
      1. Shao (2021) Emerg Infect Dis 27(12): 3175-8 [PubMed]
    3. Tetanus Vaccine and hepatitis Vaccines also have minimal increased risk
  4. Monoclonal Antibodies
    1. Rituximab
    2. Alemtuzumab
    3. Efalizumab

X. Course

  1. Symptoms may develop within hours to days
  2. Peak timing
    1. Peaks by 2 weeks in 50% of cases
    2. Peaks by 3 weeks in 80% of cases
    3. Peaks by 4 weeks in 100% of cases
  3. Respiratory Failure requiring Mechanical Ventilation (25% of hospitalized cases)
    1. Onset within 1-2 weeks of symptoms
  4. Mortality: 3 to 8%

XI. Symptoms

  1. Typically follows acute infectious illness
    1. Acute respiratory illness (fever, cough, Sore Throat)
    2. Acute gastrointestinal illness (Vomiting, Diarrhea)
      1. More likely to be associated with longer recovery and greater Disability (AMAN, AMSCAN subtypes)
  2. Progressive and ascending neurologic changes
    1. See signs below for more detailed description
    2. Tingling Paresthesias in distal extremities
    3. Proximal Muscle Weakness
  3. Myalgias (50% of cases)
    1. Deep, often severe aching pain in weak Muscles
    2. Worse with movement, and at night
    3. Distribution (most common sites)
      1. Shoulder
      2. Back
      3. Posterior thighs
  4. Autonomic Symptoms (70% of cases)
    1. Diarrhea (21%) or Constipation (22%)
    2. Urinary Retention

XII. Signs

  1. Progressive, symmetric neurologic symptoms
    1. Classically starts in distal extremities and ascends
      1. However lesions are random and patients may present first with Cranial Nerve deficit
    2. Progresses proximally over days to weeks (peaking by 2 to 4 weeks)
      1. Paresthesias (tingling) in distal extremities
      2. Proximal Muscle Weakness
        1. All limbs are ultimately affected at peak effects in 93% of cases
      3. Cranial Nerves may be affected
        1. Facial Muscles and eye movements may be affected (30-50% of cases)
        2. Ophthalmoplegia is rare except for in the Miller Fisher subtype
        3. Swallowing may be difficult
  2. Progressive, symmetric proximal Muscle Weakness
    1. Legs are affected more than arms (due to longer Neurons more apt to accumulate damage)
    2. Often onset in the legs and ascends to involve arms
    3. Observe patient standing and walking if possible
  3. Severe weakness (10-30% of cases)
    1. Quadriparesis
    2. Respiratory arrest requiring Ventilator support
    3. Bulbar failure (e.g. Dysphagia)
  4. Loss of Deep Tendon Reflexes (hyporeflexia)
    1. Onset within first few days
    2. Include DTR exam on every Neurologic Exam
    3. In combination with progressive symmetric motor weakness, hyporeflexia should raise GBS suspicion
  5. Variable sensory losses
    1. Most prevalent in AMSCAN subtype (rare)
  6. Autonomic Dysfunction
    1. Hyperhidrosis
    2. Postural Hypotension and Blood Pressure fluctuation
    3. Tachycardia
    4. Urinary Retention
    5. Gastrointestinal pseudo-obstruction
    6. Dysrhythmias

XIII. Labs

  1. Complete Blood Count
    1. Typically normal in GBS
  2. Comprehensive Metabolic Panel
    1. Typically normal in GBS
  3. Acute Phase Reactants (ESR, C-RP)
    1. Typically normal in GBS
  4. HIV Test (consider rapid Serology)
  5. Serum Vitamin B12
  6. Lumbar Puncture (see diagnostics below)
  7. Antibody Testing (e.g. Miller Fisher related antibodies, )

XIV. Imaging

  1. MRI Spine
    1. Evaluate for other causes (e.g. Transverse Myelitis, Compressive Neuropathy)

XV. Diagnostics

  1. Cerebrospinal fluid (CSF)
    1. Albuminocytologic dissociation
      1. CSF Protein increased without increase in CSF White Blood Cells
      2. Present only in 44 to 81% of cases early in disease (increases by second week)
      3. False Positives in older patients who may have unrelated increase in CSF Protein
    2. Increased CSF Protein >0.55 g/dl
      1. Increased by week 2 of symptoms in 90% of cases
    3. Normal CSF White Blood Cells Count (<50 cells/uL, some guidelines use cut-off of <10 cells/uL)
      1. If increased, then consider other diagnosis
      2. Differential diagnosis if CSF WBCs increased
        1. Lyme Disease
        2. Cancer
        3. Human Immunodeficiency Virus (HIV Infection)
        4. Sarcoid Meningitis
  2. Electromyogram (EMG)
    1. Slowing of Nerve Conduction to <60% of normal velocity within weeks of onset in 80% of cases
      1. Obtain after 10 to 14 days of symptoms
      2. Poorly diagnostic in first 4 days of symptoms (diagnostic in <30%)
    2. Specific findings
      1. Absent H reflex
      2. Low to absent sensory Action Potential amplitudes
      3. F Wave response prolonged
  3. Evaluate respiratory function in all suspected cases
    1. Pulmonary Function Testing
    2. Arterial Blood Gas
  4. Autonomic Dysfunction related Dysrhythmias are not uncommon
    1. Electrocardiogram on presentation
    2. Continuous telemetry monitoring

XVI. Diagnosis: Major Criteria

  1. Bilateral, relatively symmetric weakness or sensory deficit (typically with onset in legs)
  2. Decreased or absent Deep Tendon Reflexes
  3. Progressive and peaks within 4 weeks
  4. Not due to other cause (e.g. Acute HIV Infection, Wernicke Encephalopathy, Tickborne Illness)

XVII. Differential Diagnosis: General

  1. See Acute Motor Weakness Causes
  2. See Symmetric Peripheral Neuropathy
  3. See Peripheral Neuropathy
  4. See Acute Motor Weakness Causes
  5. See Drug-Induced Polyneuropathy
  6. Brainstem Conditions
    1. Cerebrovascular Accident
    2. Encephalitis
    3. Meningitis
  7. Spinal Conditions
    1. Cord Compression (e.g. central spinal stenosis)
    2. Myelopathy
    3. Poliomyelitis (esp. underimmunized, age <5 years old)
    4. Transverse Myelitis
  8. Muscular (and neuromuscular) Conditions
    1. Hypokalemia (includes periodic paralysis)
    2. Hypohosphatemia
    3. Myopathy
    4. Rhabdomyolysis
    5. Myasthenia Gravis
  9. Polyneuropathy conditions
    1. Arsenic
    2. Botulism
    3. Chronic inflammatory demyelinating Polyneuropathy
    4. Diabetic Neuropathy
    5. Diphtheria
    6. Lambert-Eaton Syndrome
    7. Lyme Disease
    8. HIV Infection (especially Acute Retroviral Syndrome)
    9. Wernicke Encephalopathy
    10. Lymphoma
    11. n-hexane (exposure with Inhalant Abuse)
    12. Paraneoplastic conditions
    13. Porphyria
    14. Sarcoidosis
    15. Tick Paralysis
    16. Uremia
    17. Vasculitis

XVIII. Differential Diagnosis: Findings Suggestive of Alternative Diagnosis

  1. Neurotoxic findings
    1. Porphyria
    2. Diphtheria
    3. Botulism
    4. Toxic Neuropathy
    5. Inhalant Abuse
    6. Occupational exposures
    7. Lead Poisoning
    8. Alcohol Abuse (e.g. Wernicke Encephalopathy, Vitamin B12 Deficiency)
  2. Exam and lab findings not suggestive of Guillain-Barre
    1. Pure sensory deficits (sensory-only GBS is rare)
    2. Significant asymmetric neurologic symptoms or findings
      1. By 4 weeks, findings are typically symmetric
    3. Well demarcated line of senory deficit
    4. Bowel or Bladder symptoms predominate
    5. CSF Leukocytosis (see diagnostics)
    6. Mental status changes (except Bickerstaff Brainstem Encephalitis)
    7. Findings worsening after 8 weeks
    8. Positive Babinski Reflex
    9. Clonus present

XIX. Management: Criteria for ICU admission (risk of Respiratory Failure)

  1. Pulmonary Function Test abnormalities with expected need for Mechanical Ventilation
    1. See Endotracheal Intubation indications below
    2. Forced Vital Capacity (FVC) <50% of predicted
      1. Intubation Indicated for FVC <20 ml/kg (or more than 30% drop from prior FVC)
    3. Negative inspiratory pressure (NIF) >-30 cm H2O
      1. Intubation Indicated for NIF >-20 to -30 cm H2O
  2. Poor Swallowing
  3. Ineffective cough
  4. Aspiration Pneumonia
  5. Autonomic Dysfunction
  6. Increased Respiratory Rate
  7. Dyspnea
  8. Severe Muscle Weakness
    1. Unable to lift elbows above bed or flex arms
    2. Unable to lift head above bed
    3. Unable to stand
  9. Other predictors of Respiratory Failure and Mechanical Ventilation
    1. Rapid progression of symptoms over <7 days
    2. Arm weakness
    3. Elevated Liver Function Tests
    4. Bulbar palsy

XX. Management: Indications for Endotracheal Intubation

  1. Endotracheal Intubation is required in up to 30% of GBS patients
  2. Consider when patient reports Dyspnea
  3. Forced Vital Capacity <20 ml/kg (or more than 30% drop from prior FVC)
    1. Some criteria differentiate with bulbar weakness
    2. Vital Capacity 15-18 ml/kg with bulbar weakness
    3. Vital Capacity <15 ml/kg without bulbar weakness
  4. Pressure measurement criteria
    1. Maximal expiratory pressure <40 cm H2O
    2. Maximal Inspiratory Pressure <20 to 30 cm H2O
      1. Negative inspiratory pressure (NIF) >-20 to -30 cm H2O

XXI. Management: Supportive care

  1. Admit all patients with suspected GBS (preferably to facility with neurology)
    1. Rapid clinical decompensation is not uncommon
  2. Monitor for Respiratory Failure (25%)
    1. Negative inspiratory pressure (NIF)
    2. Incentive Spirometry
    3. Control Secretions
  3. Monitor for autonomic failure
    1. Arrhythmias (EKG, continuous telemetry)
    2. Blood Pressure abnormalities
  4. Turn patient frequently (prevents Decubitus Ulcers)
  5. Subcutaneous Heparin (prevents Pulmonary Embolism)
  6. Fluid management (Observe for SIADH with low Sodium)
  7. Nutrition
  8. Monitor for infections (Urinary Tract Infection in 20%)
  9. Prevent exposure Keratitis
  10. Physical therapy reduces pain
    1. Gentle massage
    2. Range of motion
    3. Position changes
  11. Pain management (significant pain in affected Muscles)
    1. See physical therapy above
    2. NSAIDs
    3. Narcotics (use caution due to ileus)
    4. Carbamazepine (Tegretol)
    5. Gabapentin (Neurontin)
    6. Corticosteroids are no longer recommended
      1. Van Der Meche (1992) N Engl J Med 326:1123-9 [PubMed]
  12. Ventilatory management
    1. See Endotracheal Intubation
    2. Rapid Sequence Intubation
      1. As with other neuromuscular disorders, avoid Succinylcholine for paralysis
      2. Acetylcholinesterase receptors are upregulated with increased risk for Hyperkalemia
        1. Neuromuscular Blockade risks ventricular Arrhythmia
    3. Indicators to start weaning
      1. Vital Capacity > 15 ml/kg (if no lung disease)
    4. Weaning
      1. First: Change Ventilator to IMV
      2. Later: lower the Respiratory Rate

XXII. Management: Specific Treatment

  1. General
    1. Best efficacy if treatment given within first 2 weeks
      1. May administer up to 4 weeks from onset (esp. if unable to ambulate)
    2. Both plasma exchange and IV-Ig are equally effective (choose one)
    3. Corticosteroids are not recommended (contrast with Transverse Myelitis)
      1. No evidence of improved outcome
      2. Risk of delayed recovery, and worse longterm outcomes
  2. Plasma Exchange (Plasmapheresis)
    1. Protocol
      1. Number of exchanges depends on severity (up to five exchanges total)
        1. Mild Guillain-Barre: 2 exchanges
        2. Moderate to severe Guillain-Barre: 4-5 exchanges
      2. Perform one exchange every other day for 4 to 10 days (2-5 exchanges)
      3. Best outcomes if started within first 7 days from onset
    2. Special Indications
      1. Pregnancy
      2. Renal Insufficiency
      3. IgA deficient
      4. Has not been studied in children
  3. IV Immunoglobulin
    1. Easier management with fewer complications than plasma exchange
    2. Dose
      1. Standard: IV-Ig 400 mg/kg daily for 5-7 days
      2. Alternative: IV-Ig 2g/kg total with divided dosing over 2 days
    3. Special Indications
      1. Children
      2. Poor venous access
      3. Autonomic instability

XXIII. Prognosis

  1. Full recovery within 6-12 months in 75 to 85% of cases
    1. Children tend to have shorter courses with more rapid recovery and with typical complete recovery
    2. Recovery is typically complete by 12 months after onset (10 weeks on average)
  2. Neurologic sequelae in up to 15-20%
    1. Foot Drop
    2. Hand intrinsic Muscle Weakness
    3. Sensory Ataxia
    4. Unable to ambulate without assistance in 10-20% (6% in children)
  3. Median hospitalization duration: 7 days
  4. Relapse or recurrence rate <3-5%
    1. Relapse more common in women and children (typically after 7 years)
    2. Vaccination avoidance places the patient at greater risk than the risk of GBS recurrence
  5. Mortality rate <3-8% overall (regardless of age, including children)
    1. Mortality approaches 20% in some studies if Mechanical Ventilation required
    2. Highest mortality causes
      1. Ventilator Associated Pneumonia
      2. Autonomic Dysfunction (esp. Dysrhythmias resulting in Cardiac Arrest)
      3. Acute Respiratory Distress Syndrome
      4. Pulmonary Embolism
      5. Sepsis
  6. Predictors of poor prognosis or longterm Disability
    1. Age over 60 years
    2. Rapidly progressive, severe disease
    3. EMG showing axonal loss
    4. Prolonged Mechanical Ventilation >1 month
    5. Absence of motor response
    6. Inability to walk at 14 days
  7. Trigger conditions associated with worse outcomes
    1. Preceding Diarrheal illness (often Campylobacter jejuni)
    2. Cytomegalovirus infection

XXIV. Resources

  1. National Institute of Neurological Disorders and Stroke (NINDS)
    1. http://www.ninds.nih.gov/disorders/gbs/gbs.htm
  2. Guillain-Barre and Chronic Inflammatory Demyelinating Polyneuropathy Foundation International
    1. http://www.gbs-cidp.org/

XXV. References

  1. Della-Giustina (2024) Crit Dec Emerg Med 38(10): 27-34
  2. Gallagher in Marx (2002) Rosen's Emergency Med, p. 1510
  3. Lindquist and Stephanos in Swadron (2023) EM:Rap 37(3): 4-12
  4. Shields in Goetz (2003) Neurology, p. 1085-90
  5. Weinstock et al. in Herbert (2015) EM:Rap 15(1): 7
  6. Alshekhlee (2008) Neurology 70(18): 1608-13 [PubMed]
  7. Cornblath (2009) Ann Nuerol 66(5): 569-70 [PubMed]
  8. Joseph (2002) Adolesc Med 13:487-94 [PubMed]
  9. Newswanger (2004) Am Fam Physician 69(10):2405-10 [PubMed]
  10. van Doorn (2008) Lancet Neurol 7(10): 939-50 [PubMed]
  11. Walling (2013) Am Fam Physician 87(3): 191-7 [PubMed]

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Related Studies

Ontology: Guillain-Barre Syndrome (C0018378)

Definition (MEDLINEPLUS)

Guillain-Barre syndrome is a rare disorder that causes your immune system to attack your peripheral nervous system (PNS). The PNS nerves connect your brain and spinal cord with the rest of your body. Damage to these nerves makes it hard for them to transmit signals. As a result, your muscles have trouble responding to your brain. No one knows what causes the syndrome. Sometimes it is triggered by an infection, surgery, or a vaccination.

The first symptom is usually weakness or a tingling feeling in your legs. The feeling can spread to your upper body. In severe cases, you become almost paralyzed. This is life-threatening. You might need a respirator to breathe. Symptoms usually worsen over a period of weeks and then stabilize.

Guillain-Barre can be hard to diagnose. Possible tests include nerve tests and a spinal tap. Most people recover. Recovery can take a few weeks to a few years. Treatment can help symptoms, and may include medicines or a procedure called plasma exchange.

NIH: National Institute of Neurological Disorders and Stroke
Definition (MSHCZE) Zánětlivé onemocnění nervových kořenů, které se projevuje porušenou citlivostí a hybností končetin. Kromě míšních kořenů mohou být postiženy i hlavové nervy, popř. i další části CNS. Podle postižení a průběhu se rozlišují různé formy (např. ascendentní, descendentní, pseudomyopatická s nápadnými svalovými atrofiemi aj.). Vzniká sekundárně, předpokládá se, že patogeneticky se uplatňují autoimunitní procesy charakteru vaskulitidy v oblasti míšních kořenů. Obv. následuje po chřipkovém onemocnění či jiné infekci (např. při Lymeské borrelióze), které zřejmě chorobu iniciují. Po několika týdnech dochází většinou k uzdravení, jen někdy choroba postupuje dále a postihuje i dýchací svaly (Landryho vzestupná paralýza). Terapie je zaměřena imunosupresivně (kortikoidy, imunosupresiva, plasmaferéza), podávají se rovněž vitaminy skupiny B, významná je rehabilitace. Syn. polyradikuloneuritida. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) An acute, autoimmune inflammatory process affecting the peripheral nervous system and nerve roots. It results in demyelination. It is often caused by an acute viral or bacterial infection.
Definition (MSH) An acute inflammatory autoimmune neuritis caused by T cell- mediated cellular immune response directed towards peripheral myelin. Demyelination occurs in peripheral nerves and nerve roots. The process is often preceded by a viral or bacterial infection, surgery, immunization, lymphoma, or exposure to toxins. Common clinical manifestations include progressive weakness, loss of sensation, and loss of deep tendon reflexes. Weakness of respiratory muscles and autonomic dysfunction may occur. (From Adams et al., Principles of Neurology, 6th ed, pp1312-1314)
Definition (CSP) progressive ascending motor neuron paralysis of unknown etiology, frequently following an enteric or respiratory infection.
Concepts Disease or Syndrome (T047)
MSH D020275
ICD9 357.0
ICD10 G61.0
SnomedCT 40956001, 155082001, 193173004, 267707000, 193176007, 314091000009101, 128085000, 129131007, 193174005
English Syndrome, Guillain-Barre, GUILLAIN BARRE SYNDROME, GUILLAIN-BARRE SYNDROME, PARALYSIS ASCENDING, Acute infective polyneurit.NOS, Acute infective polyneuritis NOS, Acute postinfec radiculoneurop, GBS - Guillain-Barre syndrome, acute idiopathic polyneuritis, GBS, POLYNEUROPATHY, INFLAMMATORY DEMYELINATING, ACUTE, AIDP, GUILLAIN-BARRE SYNDROME, FAMILIAL, Guillain-Barre Syndrome, ACUTE INFLAMM POLYRADICULONEUROPATHY, DEMYELINATING POLYRADICULONEUROPATHY ACUTE INFLAMM, INFLAMM POLYNEUROPATHY ACUTE, POLYNEUROPATHY ACUTE INFLAMM, POLYRADICULONEUROPATHY ACUTE INFLAMM DEMYELINATING, INFLAMM DEMYELINATING POLYRADICULONEUROPATHY ACUTE, ACUTE INFLAMM POLYNEUROPATHY, POLYRADICULONEUROPATHY ACUTE INFLAMM, ACUTE INFLAMM DEMYELINATING POLYRADICULONEUROPATHY, acute postinfectious polyneuropathy, Landry's paralysis, postinfectious polyneuritis, Guillain-Barre syndrome (diagnosis), acute infectious polyneuritis (diagnosis), acute infectious polyneuritis, Paralysis ascending, Syndrome Guillain-Barre, Acute Autoimmune Neuropathies, Acute Autoimmune Neuropathy, Autoimmune Neuropathies, Acute, Autoimmune Neuropathy, Acute, Neuropathies, Acute Autoimmune, Neuropathy, Acute Autoimmune, Acute Inflammatory Demyelinating Polyradiculoneuropathy, Demyelinating Polyradiculoneuropathy, Acute Inflammatory, Inflammatory Demyelinating Polyradiculoneuropathy, Acute, Polyradiculoneuropathy, Acute Inflammatory Demyelinating, Acute Inflammatory Polyneuropathies, Inflammatory Polyneuropathies, Acute, Polyneuropathies, Acute Inflammatory, Acute Inflammatory Polyneuropathy, Inflammatory Polyneuropathy Acute, Inflammatory Polyneuropathy, Acute, Polyneuropathy, Acute Inflammatory, Acute Inflammatory Polyradiculoneuropathies, Inflammatory Polyradiculoneuropathies, Acute, Polyradiculoneuropathies, Acute Inflammatory, Acute Inflammatory Polyradiculoneuropathy, Polyradiculoneuropathy, Acute Inflammatory, Landry Guillain Barre Syndrome, Landry-Guillain-Barre Syndrome, Syndrome, Landry-Guillain-Barre, Guillaine Barre Syndrome, Guillaine-Barre Syndrome, Syndrome, Guillaine-Barre, Guillain-Barre syndrome (disorder), Guillain-Barre syndrome, Guillain-Barré syndrome, Guillain-Barré syndrome (disorder), Ac infect polyneuritis, Acute, Inflammatory Polyneuropathy, Polyneuropathy Acute, Inflammatory, Acute Inflammatory Demyelinating Polyneuropathy, Inflammatory Polyneuropathy Acutes, Guillain-Barre Syndrome [Disease/Finding], guillain barre syndrome, acute infective polyneuritis, ascending paralysis, landry's paralysis, guillain-barre syndrome, guillain-barre syndrome (GBS), acute inflammatory demyelinating polyradiculoneuropathy (AIDP), guillain-barre disease, aidp, Guillain Barre syndrome, Acute inflammatory polyneuropathy, Infectious polyneuritis, Guillain-Barré Syndrome, Guillain-Barre Syndrome, Familial, Acute Infectious Polyneuritis, Polyneuropathy, Inflammatory Demyelinating, Acute, Acute infective polyneuritis (& [Guillain-Barre syndrome]) (disorder), Acute inf. polyneuritis, Acute infective polyneuritis NOS (disorder), Acute infective polyneuritis (& [Guillain-Barre syndrome]), Ascending paralysis (finding), Infectious neuronitis, Landry-Guillain-Barre syndrome, Ascending paralysis, Acute infective polyneuritis, Acute inflammatory neuropathy, Acute post-infective radiculoneuropathy, Post-infectious polyneuritis, Acute idiopathic polyneuritis, Acute idiopathic polyradiculoneuritis, Acute infective polyneuritis (disorder), Infectious neuronitis (disorder), Landry-Guillain-Barré syndrome, Post-infectious polyneuritis (disorder), Acute inflammatory demyelinating polyradiculoneuropathy, ascending; paralysis, Guillain-Barré, Landry-Guillain-Barré, Landry; paralysis, Barré-Guillain, infective; polyneuritic, multiple; neuritis, infective, acute, neuritis; multiple, infective, acute, paralysis; Landry, paralysis; ascending, polyneuritis; acute, polyneuritis; infective, polyneuritis; postinfective, postinfective; polyneuritic, PNS neuronitis, Guillain Barre Syndrome, Acute Infective Polyneuritis, Postinfectious polyneuritis
Spanish SINDROME DE GUILLAIN-BARRE, Parálisis ascendente, Polineuritis infecciosa aguda, Síndrome de Guillain Barré, Polirradiculoneuropatía aguda inflamatoria desmielinizante, PARALISIS ASCENDENTE, neuronitis PNS, polirradiculoneuritis idiopática aguda, polineuritis idiopática aguda, neuropatía inflamatoria aguda, polineuritis infecciosa aguda, SAI (trastorno), polineuritis infecciosa aguda, SAI, neuronitis infecciosa (trastorno), neuronitis infecciosa, parálisis ascendente, polineuritis infecciosa aguda (trastorno), polineuritis infecciosa aguda, polineuritis posinfecciosa (trastorno), polineuritis posinfecciosa, síndrome de Guillain - Barré (trastorno), síndrome de Guillain - Barré, síndrome de Landry - Guillain - Barré, Síndrome de Guillain-Barré, Neuropatía Autoinmune Aguda, Polineuropatía Inflamatoria Aguda, Polirradiculoneuropatía Aguda Inflamatoria, Polirradiculoneuropatía Desmielinizante Inflamatoria Aguda, Síndrome de Guillain-Barre, Síndrome de Landry-Guillain-Barre
Italian Sindrome di Guillain-Barre, Paralisi ascendente, Polineurite infettiva acuta, Polineuropatia infiammatoria acuta, Poliradicoloneuropatia infiammatoria acuta demielinizzante, AIDP, Neuropatia immunomediata acuta, Poliradicoloneuropatia infiammatoria acuta, Sindrome di Landry-Guillain-Barré, GBS, Sindrome di Guillain-Barré
Dutch paralyse opstijgend, Guillain Barré syndroom, acute infectieuze polyneuritis, syndroom Guillain-Barré, acute inflammatoire demyeliniserende polyradiculoneuropathie, Landry; paralyse, ascendans; paralyse, infectieus; polyneuritis, multipel; neuritis, infectieus, acuut, neuritis; multipel, infectieus, acuut, paralyse; Landry, paralyse; ascendans, polyneuritis; acuut, polyneuritis; infectieus, polyneuritis; postinfectieus, postinfectieus; polyneuritis, Syndroom van Guillain-Barrs, AIDP, Acute auto-immuunneuropathie, Acute inflammatoire demyeliniserende polyradiculoneuropathie, Acute inflammatoire polyneuropathie, Polyradiculoneuropathie, acute inflammatoire, Guillain-Barré-syndroom, Landry-Guillain-Barré-syndroom, Syndroom, Guillain-Barré-
French Polynévrite aiguë infectieuse, Paralysie ascendante, Polyradiculonévrite démyélinisante inflammatoire aigüe, PARALYSIE ASCENDANTE, SYNDROME DE GUILLAIN-BARRE, Polyradiculoneuropathie inflammatoire démyélinisante aiguë, Syndrome de Guillain-Barre, Polyradiculonévrite aiguë inflammatoire, Polyradiculonévrite de Guillain-Barré, Syndrome de Guillain-Barré, Syndrome de Landry-Guillain-Barré, Polyradiculonévrite démyélinisante inflammatoire aiguë, SGB (Syndrome de Guillain-Barré)
German Guillain Barre Syndrom, Syndrom, Guillain-Barre, akute infektioese Polyneuritis, Paralyse, aufsteigend, akut inflammatorische demyelinisierende Polyradikulpathie, GUILLAIN-BARRE SYNDROM, Guillain-Barre-Syndrom, LAEHMUNG AUFSTEIGEND, AIDP, Akute autoimmune Neuropathie, Akute entzündliche demyelinisierende Polyradikuloneuropathie, Akute entzündliche Polyneuropathie, Guillain-Barré-Syndrom, Landry-Guillain-Barré-Syndrom, Polyradikuloneuritis Typ Guillain-Barré, Polyradikuloneuropathie, akute entzündliche
Portuguese Paralisia ascendente, Polinevrite infecciosa aguda, PARALISIA ASCENDENTE, SINDROME DE GUILLAIN BARRE, Poliradiculoneuropatia inflamatória desmielinizante aguda, Neuropatia Autoimune Aguda, Polineuropatia Inflamatória Aguda, Polirradiculoneuropatia Desmielinizante Inflamatória Aguda, Polirradiculoneuropatia Inflamatória Aguda, Síndrome de Guillain-Barré, Síndrome de Landry-Guillain-Barré
Japanese ギラン・バレー症候群, 上行性麻痺, ｼﾞｮｳｺｳｾｲﾏﾋ, ｷﾞﾗﾝﾊﾞﾚｰｼｮｳｺｳｸﾞﾝ, ｷｭｳｾｲｶﾝｾﾝｾｲﾀﾊﾂｼﾝｹｲｴﾝ, ｷｭｳｾｲｴﾝｼｮｳｾｲﾀﾞﾂｽﾞｲｾｲﾀﾊﾂｺﾝﾆｭｰﾛﾊﾟﾁｰ, 急性炎症性脱髄性多発根ニューロパチー, ギラン-バレー症候群, 急性自己免疫性神経障害, 急性特発性多発性神経炎, 自己免疫性神経障害-急性, 自己免疫性ニューロパシー-急性, 多発神経炎-感染性-急性, バレー-ギラン症候群, 急性炎症性脱髄性多発根神経炎, 急性感染性多発性神経炎, 急性上行性脊髄麻痺, ギラン-バレ多発性神経炎, 自己免疫性神経異常症-急性, 感染後多発性神経炎, 急性感染後多発性神経炎, 急性特発性多発神経炎, 急性熱性多発性神経炎, ギラン-バレ多発神経炎, 多発神経炎-感染後, 多発神経障害-炎症性-急性, 多発性根神経障害-脱髄性-炎症性-急性, 多発性神経炎-感染後-急性, Guillain-Barre症候群, 感染後多発性神経障害-急性, 急性炎症性脱髄多発根神経障害, 急性炎症性ポリニューロパシー, ギラン･バレ症候群, 多発神経炎-感染後-急性, 多発性神経炎-感染後, ポリニューロパシー-炎症性-急性, ランドリー症候群, 炎症性ポリニューロパシー-急性, 急性炎症性多発神経障害, 急性感染後多発神経障害, 急性熱性多発神経炎, バレ-ギラン症候群, 炎症性多発神経障害-急性, 感染後多発神経炎, 感染後多発神経炎-急性, 感染後多発神経障害-急性, 感染性多発性神経炎-急性, 急性自己免疫性ニューロパシー, ギラン-バレー多発性神経炎, 神経障害-自己免疫性-急性, 脊髄麻痺-上行性-急性, 多発性神経炎-感染性-急性, 脱髄性多発根神経炎-炎症性-急性, ニューロパシー-自己免疫性-急性, 炎症性多発性神経障害-急性, 炎症性脱髄性多発根神経炎-急性, 炎症性脱髄性多発性根神経障害-急性, 感染後多発性神経炎-急性, 急性感染後多発性神経障害, 急性自己免疫性神経異常症, ギラン-バレ症候群, 神経異常症-自己免疫性-急性, 上行性脊髄麻痺-急性, 多発性神経障害-感染後-急性, 脱髄性多発性根神経障害-炎症性-急性, 急性炎症性脱髄性多発性根神経障害, 感染性多発神経炎-急性, 急性炎症性多発性神経障害, 急性感染後多発神経炎, 急性感染性多発神経炎, ギラン-バレー多発神経炎, ギラン･バレー症候群, 多発神経障害-感染後-急性, 多発性神経障害-炎症性-急性, ランドリー麻痺
Swedish Guillain-Barres syndrom
Czech Guillainův-Barrého syndrom, Landryho-Guillainův-Barrého syndrom, akutní zánětlivá demyelinizační polyradikuloneuropatie, akutní autoimunitní neuropatie, akutní zánětlivá polyneuropatie, AIDP, Akutní infekční polyneuritida, Guillain-Barre syndrom, Syndrom Guillain-Barre, Akutní zánětová demyelinizační polyradikuloneuropatie, Obrna vzestupná, Guillainův-Barréův syndrom
Finnish Polyradikuliitti
Russian NEVROPATIIA AUTOIMMUNNAIA OSTRAIA, POLIRADIKULONEVROPATIIA VOSPALITEL'NAIA OSTRAIA, POLIRADIKULONEVROPATIIA DEMIELINIZIRUIUSHCHAIA VOSPALITEL'NAIA OSTRAIA, GIIENA-BARRE SINDROM, ГИЙЕНА-БАРРЕ СИНДРОМ, НЕВРОПАТИЯ АУТОИММУННАЯ ОСТРАЯ, ПОЛИРАДИКУЛОНЕВРОПАТИЯ ВОСПАЛИТЕЛЬНАЯ ОСТРАЯ, ПОЛИРАДИКУЛОНЕВРОПАТИЯ ДЕМИЕЛИНИЗИРУЮЩАЯ ВОСПАЛИТЕЛЬНАЯ ОСТРАЯ
Korean 길랑-바레 증후군
Polish Polineuropatia zapalna, Neuropatia autoimmunologiczna ostra, Zespół Landry-Guillaina-Barrego, GBS, Zespół Guillaina-Barrego
Hungarian Felszálló bénulás, Guillain-Barré-syndroma, Guillain-Barré-tünetegyüttes, Guillain-Barré syndroma, Acut fertőző polyneuritis, Acut gyulladásos demyelinisatiós polyradiculo-neuropathia
Norwegian Guillain-Barré syndrom, Guillain-Barrés syndrom, Akutt inflammatorisk demyeliniserende polyradikulonevropati, AIDP
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Miller Fisher Syndrome (C0393799)

Definition (MSHCZE) Varianta Guillainova-Barrého syndromu s výraznou symptomatologií mozečkovou a kmenovou, zejm. vestibulární. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (MSH) A variant of the GUILLAIN-BARRE SYNDROME characterized by the acute onset of oculomotor dysfunction, ataxia, and loss of deep tendon reflexes with relative sparing of strength in the extremities and trunk. The ataxia is produced by peripheral sensory nerve dysfunction and not by cerebellar injury. Facial weakness and sensory loss may also occur. The process is mediated by autoantibodies directed against a component of myelin found in peripheral nerves. (Adams et al., Principles of Neurology, 6th ed, p1313; Neurology 1987 Sep;37(9):1493-8)
Concepts Disease or Syndrome (T047)
MSH D019846
ICD10 G61.0
SnomedCT 1767005, 193175006, 230548007
English Fisher Syndrome, Miller Fisher Syndrome, Miller-Fisher Syndrome, Miller-Fisher var Guillain-Bar, Syndrome, Fisher, Syndrome, Miller Fisher, Syndrome, Miller-Fisher, Miller-Fisher syndrome (diagnosis), Ophthalmoplegia, Ataxia and Areflexia Syndrome, Guillain Barre Syndrome, Miller Fisher Variant, Guillain-Barre Syndrome, Miller Fisher Variant, Miller Fisher Variant of Guillain Barre Syndrome, Fisher syndrome, Miller Fisher Syndrome [Disease/Finding], fisher syndrome, miller-fisher syndrome, syndrome miller fisher, miller fisher syndrome, fisher miller syndrome, Miller Fisher syndrome, Miller-Fisher variant of Guillain-Barre syndrome (disorder), Fisher's syndrome, Ophthalmoplegia, ataxia, areflexia syndrome, Miller-Fisher syndrome, Miller-Fisher variant of Guillain-Barre syndrome, Fisher's syndrome (disorder)
Italian Sindrome di Miller-Fisher, Sindrome di Fisher, Sindrome di Miller Fisher variante di Guillain Barrè, Atassia, areflessia e oftalmoplegia, MFS, Sindrome di Miller Fisher variante di Guillain-Barrè, Sindrome di Miller Fisher
Japanese ミラー・フィッシャー症候群, ﾐﾗｰﾌｨｯｼｬｰｼｮｳｺｳｸﾞﾝ, 眼筋麻痺･運動失調･無反射症候群, ギラン･バレー症候群-ミラー･フィッシャー異型, ミラー･フィッシャー異型ギラン･バレー症候群, ミラー･フィッシャー症候群, Fisher症候群, 眼筋麻痺･運動失調･反射消失症候群, フィッシャー症候群, Miller Fisher症候群, Miller-Fisher症候群, ミラー-フィッシャー症候群
Swedish Miller Fishers syndrom
Czech Miller Fisherův syndrom, Fisherův syndrom, Millerův-Fisherův syndrom, Millerův-Fischerův syndrom
Finnish Miller Fisherin oireyhtymä
Russian MILLERA FISHERA SINDROM, FISHERA SINDROM, FISHERA M. SINDROM, MILLERA-FISHERA SINDROM, МИЛЛЕРА ФИШЕРА СИНДРОМ, МИЛЛЕРА-ФИШЕРА СИНДРОМ, ФИШЕРА М. СИНДРОМ, ФИШЕРА СИНДРОМ
Spanish síndrome de Miller-Fisher, síndrome de Fisher (trastorno), síndrome de Fisher, síndrome de oftalmoplejía, ataxia, arreflexia, Síndrome de Fisher, Síndrome de Guillain Barre Variante de Miller Fisher, Síndrome de Miller Fisher, Síndrome de Oftalmoplejía, Ataxia y Arreflexia
Polish Zespół Millera-Fishera
Hungarian Miller-Fisher-syndroma
Norwegian Guillain-Barrés syndrom, variant Miller-Fisher, Miller-Fishers syndrom, Oftalmoplegi, Ataxia og Areflexia Syndrom
Portuguese Síndrome de Guillain Barre Variante de Miler Fisher, Síndrome de Fisher Miller, Síndrome de Fisher, Síndrome de Miller Fisher, Síndrome de Oftalmoplegia, Ataxia e Arreflexia, Variante Miller Fisher da Síndrome Guillain Barré
Dutch Miller Fisher syndroom, Fisher-syndroom, Miller-Fisher-syndroom, Oftalmoplegie-, ataxie- en areflexiesyndroom, Syndroom, Miller-Fisher-, Guillain-Barré-syndroom, Miller-Fisher-variant
French Syndrome de Miller-Fisher, Syndrome de Fisher, SMF (Syndrome de Miller-Fisher), Syndrome de Guillain-Barré variante Miller-Fisher, Variante Miller-Fisher du syndrome de Guillain-Barré
German Fisher-Syndrom, Miller-Fisher-Syndrom, Ophthalmoplegie-Ataxie-Areflexie-Syndrom, Polyradikuloneuritis Typ Fisher, Guillan-Barré-Syndrom, Miller-Fisher-Variante
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Bickerstaff's brainstem encephalitis (C1960543)

Concepts Disease or Syndrome (T047)
SnomedCT 427086003
English Bickerstaff encephalitis, Bickerstaff's brainstem encephalitis (disorder), Bickerstaff's brainstem encephalitis, Bickerstaff brainstem encephalitis
Spanish encefalitis de tronco de Bickerstaff (trastorno), encefalitis de Bickerstaff, encefalitis de tronco de Bickerstaff
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Acute inflammatory demyelinating polyneuropathy (C3542501)

Concepts Disease or Syndrome (T047)
SnomedCT 26261000119109
English Acute inflammatory demyelinating polyneuropathy, Acute inflammatory demyelinating polyneuropathy (disorder)
Spanish polineuropatía desmielinizante inflamatoria aguda, polineuropatía desmielinizante inflamatoria aguda (trastorno)
Derived from the NIH UMLS (Unified Medical Language System)

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