Guillain-Barré Syndrome and Neurocritical Care

Guillain-Barré Syndrome is one of the most common causes of acute onset weakness. The polyneuropathy associated with GBS is triggered by an immune response to an antecedent event in the form of infection. Following that, molecular mimicry leads to immune-mediated destruction of peripheral nerves. The presentation is diverse and is determined by the nature of the immune processes and the anatomical structures involved in the disease. Numerous variants of the disease on the basis of the pathophysiology, presentation, and presence of autoantibodies have been described in literature. Diagnosis is based on either the National Institute of Neurological Disorders and Stroke (NINDS) diagnostic criteria or the Brighton Collaboration diagnostic criteria. The Erasmus GBS Respiratory Insufficiency Score (EGRIS) and Modified Erasmus GBS Outcome Score (mEGOS) are useful and validated adjuncts to assist in management. The disease course is frequently complicated by respiratory failure and/or autonomic dysfunction. Patients require admission, preferably in a neurocritical care unit for continuous monitoring of the neurological status and hemodynamic parameters. Immunotherapy in the form of either plasma exchange or intravenous immune globulin and supportive care are the established modalities of treatment.