Guillain-Barré Syndrome

Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy. It often follows a recent gastrointestinal or respiratory infection. The immune response can target peripheral-nerve myelin, the axons themselves, or both; anti-ganglioside antibodies are often involved. The result is impaired conduction along peripheral nerves. Weakness is typically progressive and symmetrical, often beginning in the legs and moving upward. The same process can affect the nerves supplying the diaphragm, intercostal muscles, swallowing muscles, and autonomic nervous system. A patient may therefore move from walking difficulty to respiratory failure, aspiration risk, labile blood pressure, or cardiac dysrhythmia over a short period. The experienced nurse watches the trajectory, not just the current muscle grade. A patient who was able to cough, count aloud, or lift the head during the previous assessment may lose those abilities as weakness progresses. That change has greater urgency than the absolute strength score.