As might be gathered from the above descriptions, the initial and subsequent abnormalities in Guillain-Barré syndrome can be quite varied. Furthermore, the symptoms can occur quite rapidly, over hours to days, or slowly, over weeks. Thus, the diagnosis of Guillain-Barré syndrome can be difficult to make, especially in its early phase. Sometimes a person may have only developed abnormal sensations, such as tingling in the hands, feet or face or easy fatigue, when they first seek a physician's advice. In this early phase, objective evidence of a problem may be difficult to find, and the possibility of an emotional disturbance, rather than the presence of a true organic illness may be suspected.
In many patients, the typically described rapid onset of equal weakness or paralysis of both legs, and then arms, occurs, as well as numbness, or a sense of pins and needles, and the diagnosis is more rapidly made. As a general rule, if the onset of symptoms is rapid and equal on both sides of the body, the syndrome is easier to diagnose. A variety of findings on physical examination, as well as laboratory studies help the physician establish the diagnosis. Muscle strength testing shows weakness; tests of sensation reveal deficits. Reflexes, such as knee jerks, are usually lost. Conduction of electric signals by nerves become prolonged or slow and muscle responses to nerve stimulation becomes abnormal. Physicians may use instruments with needles to detect these abnormalities. Also, the fluid bathing the spinal cord in the back is usually abnormal, so that a spinal tap is helpful. (In spite of experiences in prior years, headaches are rare after this uncomfortable, but rarely painful, procedure.)
A diagnosis of Guillain-Barré syndrome is usually based upon evaluating many of the findings described above. No one observation alone is usually sufficient to make the diagnosis.
Early Hospital Stay and Care
When a diagnosis of Guillain-Barré syndrome is made, most patients are hospitalised if they are not already in such a facility. In some patients the course is often not predictable and may be downhill. Since important bodily functions, such as breathing, blood pressure, heart rate, swallowing, air clearance and bladder control can be affected, careful observation in the hospital, often in the intensive care unit, is utilised. There, rapid treatment can be given if problems arise. Several doctors may be involved in early care. These may include the family GP, the general physician, or a neurologist.
Sometimes a specialist in rehabilitation medicine is involved. In the early stages of a severe case nursing care is very important. On-going treatment by a physiotherapist is usually employed.
During the early part of the illness, especially for the few patients who require intensive care, events can be quite frightening. Most patients with Guillain-Barré syndrome were formerly healthy, so that finding themselves suddenly paralysed, helpless, with intravenous lines, a bladder catheter, and a heart beat monitor that continuously beeps can be emotionally upsetting. If the arms are too weak, even brushing teeth, feeding oneself or scratching an itch can become very frustrating. The feeling of utter helplessness, and hopelessness, thoughts of possible death, and the threat of permanent disability, dependence and income loss can be emotionally overwhelming. It is helpful for both patient and family to keep in mind that most Guillain-Barré syndrome patients get better, most eventually walk, and many can ultimately resume a normal life.