Guide for GP's

Diagnosis

The diagnosis is essentially a clinical one depending on the history of preceding infection, numbness and tingling, progression of weakness, back pain, and the findings of facial or limb weakness, and depressed or absent reflexes. The diagnosis can be difficult in the early stages because there may be few objective signs. Because of this many patients are thought simply to be anxious or hysterical and may be sent home from hospital emergency departments or doctors' surgeries only to become rapidly weak and develop respiratory paralysis at home overnight. A high index of suspicion of the disease is necessary to prevent these tragedies, and the onus is on the general practitioner to be alert to the possibility of Guillain-Barré Syndrome. Other conditions that should be included in the differential diagnosis of patient with an acute progressive paralysis include spinal cord lesions, myasthenia gravis, poliomyelitis, acquired hypokalaemia, periodic paralysis, polymyositis and botulism (Table 2).

Table 2 - Other causes of rapidly progressive weakness
Transverse myelitis
Myasthenia gravis
Poliomyelitis
Acquired hypokalaemia
Periodic paralysis
Polymyositis
Botulism

Other causes of acute neuropathy such as acute intermittent porphyria, heavy metals and other toxins, lymphoma, carcinoma of the lung, vasculitis, diptheria and Lyme disease should be excluded, as should diabetes and vitamin deficiencies (Table 3).

Table 3 - Other causes of acute polyneuritis
HIV infections
Acute intermittent porphyria
Vitamin B deficiencies
Heavy metals and other toxins
Lymphoma, carcinoma
Lyme disease
Vasculitis
Diptheria
Diabetes