High risk and low prevalence diseases: Guillain-Barr syndrome

Introduction: Guillain-Barre syndrome (GBS) is a rare but serious condition that carries with it a high rate of morbidity and mortality. Objective: This review highlights the pearls and pitfalls of GBS, including presentation, diagnosis, and manage-ment in the emergency department (ED) based on current evidence. Discussion: GBS is a rare immune-mediated neurologic disorder with peripheral nerve injury. It most commonly presents weeks after a bacterial or viral infection, though there are a variety of associated inciting events. The di-agnosis is challenging and often subtle, as only 25-30% of patients are diagnosed on their initial healthcare visit. Clinicians should consider GBS in patients with progressive ascending weakness involving the lower extremities associated with hyporeflexia, but the cranial nerves, respiratory system, and autonomic system may be involved. While the ED diagnosis should be based on clinical assessment, further evaluation includes laboratory testing, cerebrospinal fluid (CSF) analysis, and potentially neuroimaging. Not all patients demonstrate albumino-cytological dissociation on CSF testing. Several criteria exist to assist with diagnosis, including the National Institute of Neurological Disorders and Stroke criteria and the Brighton criteria. Management focuses first on assessment of the patient's hemodynamic and respiratory status, which may require emergent intervention. Significant fluctuations in heart rate and blood pressure may occur, and respiratory muscle weakness may result in the need for airway protection. Neurology consultation is recommended, and definitive treatment includes PLEX or IVIG. Conclusions: An understanding of GBS can assist emergency clinicians in diagnosing and managing this potentially deadly disease. Published by Elsevier Inc.