Guillain-Barré Syndrome and Other Neuropathies Diagnosis and Management

Primary Urgent Differential Diagnoses

The American College of Neurology suggests that Guillain-Barré syndrome (GBS) requires urgent evaluation including MRI of the entire spine, CSF analysis, and respiratory monitoring, as approximately 20% of patients develop respiratory failure requiring mechanical ventilation 1, 2
Classic presentation of GBS includes rapidly progressive bilateral weakness with paresthesias, typically ascending from legs to arms, though asymmetric patterns can occur in GBS variants 1, 2
Approximately two-thirds of GBS patients report preceding infection within 6 weeks, such as Campylobacter jejuni, CMV, Hepatitis E, Mycoplasma pneumoniae, EBV, or Zika virus 1
Red flags requiring immediate action in GBS include areflexia/hyporeflexia, check vital capacity and negative inspiratory force, and monitor for dysautonomia, with a strength of evidence level of high 1, 2

Bilateral hand involvement with unilateral foot weakness suggests a cervical cord lesion at C5-C7 level affecting both upper extremities and descending motor tracts, according to the World Federation of Neurosurgical Societies 3, 4
The European Federation of Neurological Societies recommends that uremic neuropathy from renal insufficiency should be considered, with a check of creatinine, eGFR, and urinalysis 5
Fabry disease can present with episodic acroparesthesias as constant burning pain and tingling in feet and hands, though typically begins earlier in life, as stated by the American College of Medical Genetics and Genomics 6

The American Academy of Neurology suggests an urgent MRI of the entire spine without and with contrast to exclude cord compression, transverse myelitis, or nerve root enhancement, with a strength of evidence level of high 2
CSF analysis, including cell count, protein, glucose, and oligoclonal bands, is recommended by the American College of Neurology 1, 2

If GBS is confirmed or highly suspected, the American College of Neurology recommends initiating treatment urgently with IVIG 2 g/kg over 5 days or plasmapheresis, with a strength of evidence level of high 2
Admission to a monitored setting with respiratory monitoring capability is advised by the American Academy of Neurology 2
Monitoring for dysautonomia and pain is recommended by the American College of Neurology, with a strength of evidence level of moderate 1, 2