🧠Guillain-Barré Syndrome (GBS): Ascending Paralysis on the USMLE
Guillain-Barré Syndrome is a life-threatening autoimmune polyradiculoneuropathy characterized by rapidly progressive ascending weakness. It’s a frequently tested clinical syndrome on Step 1, Step 2, and Step 3 due to its classic pattern, unique CSF finding, and association with infections.
USMLE Pearl: Weakness → starts in the legs → ascends. Reflexes? Absent.
🧬 Pathophysiology
Autoimmune destruction of Schwann cells or myelin in peripheral nerves
Often follows a GI or respiratory infection (especially Campylobacter jejuni)
Molecular mimicry → immune attack on peripheral myelin → demyelination + slowed conduction
⚠️ Classic Triggers
| Infection Type | Example |
|---|---|
| GI | Campylobacter jejuni, CMV |
| Respiratory | Mycoplasma, influenza |
| Vaccine-related (rare) | Influenza shot |
🧪 Clinical Features
| Symptom | Description |
|---|---|
| Weakness | Ascending, symmetric; starts in legs, progresses upward |
| Reflexes | Absent (areflexia) |
| Sensation | Often intact or mildly affected |
| Cranial Nerves | Facial weakness, dysphagia |
| Autonomic | Tachycardia, hypotension, arrhythmia |
⚠️ USMLE Warning Sign: Respiratory failure is the most feared complication → Check vital capacity!
🧬 CSF Finding
| Test | Result |
|---|---|
| Lumbar puncture | Albuminocytologic dissociation (↑ protein, normal WBCs) |
🧑‍⚕️ Management
| Step | Treatment |
|---|---|
| 1 | Monitor respiratory status (vitals, spirometry) |
| 2 | IVIG or plasmapheresis (never both!) |
| 3 | Supportive care: fluids, anticoagulation, rehab |
| đźš« | No steroids (contraindicated) |
đź“š Sample USMLE Vignette
A 28-year-old man develops progressive leg weakness 1 week after diarrhea. Reflexes are absent. CSF shows high protein, no WBCs. What’s the diagnosis?
✅ Guillain-Barré Syndrome
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