The clinical manifestations of Guillain-Barre syndrome occur within about 3 weeks of the onset of a viral illness in up to 60% of cases. Other possible antecedent events include Campylobacter and Mycoplasma pneumoniae infections (1). Early symptoms may include pain suggestive of nerve root irritation and paraesthesia of the legs and feet. Back pain is an occasional initial presentation.
The cranial nerves may be affected, most commonly, the facial nerve. Cranial nerves I and VIII are not affected. Facial weakness may precede other neurological findings. It is often unilateral and may be indistinguishable from Bell's palsy.
Muscle weakness evolves over a period of 3 to 21 days. It may be generalised, proximal in distribution, or commence distally and ascend. In severe cases, there is respiratory and bulbar involvement. Tendon reflexes are lost but plantar responses remain normal.
There may be autonomic involvement - fluctuating blood pressure, tachycardia and urinary retention.
Sensory signs are infrequent.
5% of patients develop chronic disease (CIDP) characterised by progressive or relapsing and remitting symptoms.
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