Guillain-Barré: autonomic dysfxn

Guillain-Barre Syndrome is characterized as an acute inflammatory demyelinating peripheral polyneuropathy secondary to an autoimmune response in association with an infectious process. Classically the syndrome is described as an ascending paralysis, starting in the legs and progressing cephalad. There are multiple variants of GBS; ascending weakness may or may not be accompanied by dysesthesias or in the most severe form autonomic dysfunction.

Autonomic Dysfunction is a common complication of GBS and is very important to identify early. Both the sympathetic & parasympathetic nervous systems may be involved. The most commonly involved organ systems are cardiovascular, gastrointestinal and sudomotor. The cardiovascular complications are particularly important as they can be life threatening. Common manifestations include hypertension, hypotension, and brady/tachyarrytmias. Identifying patients can be life saving in that some patients may require pacemaker placement. Gastrointestinal symptoms are less likely to be life threatening; however, they can delay diagnosis. Patients often experience constipation or diarrhea, abdominal bloating, urinary retention or bladder dysfunction that can masquerade as a viral illness. With respect to sudomotor involvement, some GBS patients have been shown to have decreased innervation of sweat glands. In and of itself, this is not necessarily lethal, but it does indicate that other small nerve fibers may be diseased in those patients.