Guillain-Barré syndrome (GBS) is a dangerous and under certain circumstances life-threatening
immune-mediated polyneuropathy of acute onset, often subsequent to respiratory or diarrheal
illness. Patients usually present with distal onset of slight sensory symptoms such as
numbness and tingling followed by ascending weakness of arms and legs, often involving
cranial nerves Typical clinical findings are symmetric, flaccid paresis, reduced or absent
deep tendon reflexes, and slight sensory symptoms only. Many variants of GBS such as
pharyngeal-brachial or bulbar variants exist; the Miller-Fisher syndrome (MFS) with ataxia,
areflexia, and oculomotor dysfunction; or the Elsberg syndrome with accentuated involvement
of the autonomic nervous system. Diagnosis of GBS is normally based on typical clinical
onset, laboratory findings, and electrophysiological studies.
In literature, Campylobacter jejuni infection is the most commonly identified precipitant of
GBS. Cytomegalovirus, Epstein-Barr virus, human immunodeficiency virus (HIV), and Zika virus
have also been reported with GBS [5]. A small percentage of patients develop GBS after other
triggering events such as immunization, surgery, trauma, and bone-marrow transplantation.
Autonomic dysfunction (AD) in GBS predominantly occurs in the acute phase of the illness but
can manifest in the recovery phase too. The exact mechanism remains unknown but probably
involves dysfunction in the sympathetic and parasympathetic systems [8].
AD in GBS is observed in 70% of the cases [7]; features including tachycardia, bradycardia,
facial flushing, hypertension alternating with hypotension, orthostatic hypotension,
anhydrosis or diaphoresis, and urinary retention while gastrointestinal autonomic
manifestation includes diarrhea or constipation [9]. Severe autonomic dysfunction is an
important factor to recognize and treat accordingly as this is occasionally associated with a
sudden death rate of 5-7% [10,11].
Guillain-Barré Syndrome (GBS) is often accompanied by respiratory failure that necessitates
mechanical ventilation (MV).1 About 20-30% of cases require respiratory support.2-4 Major
complications, including pulmonary infections, sepsis and pulmonary embolism, are reported in
60% of intubated patients with GBS.5, 6 The worldwide mortality rate for ventilated patients
ranges from 15% to 30%, with survivors usually having poor outcomes.7 . Multiple clinical and
biological parameters have been identified as risk factors for impending respiratory failure
in GBS,9, 10 including cranial nerve involvement, disability grade on admission, rapidly
progressive motor weakness, an absence of deep tendon reflexes, autonomic dysfunction, and
features of nerve conduction block on electromyography.11-14
Facial nerve is commonly involved in GBS, occurring in at least half of patients. Other
cranial nerves like bulbar nerves, abducent, oculomotor, optic, hypoglossal nerves are less
often affected Ultrasound (US) is a reliable, effective, noninvasive, and well tolerated
technique that allows multiple nerves to be examined in a relatively short period. Ultrasound
(US) studies have demonstrated patchy enlargement of cranial nerves in Guillain-Barré
syndrome (GBS). However, whether ultrasound yields useful information for early
classification of GBS has not been established. We aimed to evaluate nerve ultrasound in
patients with GBS in assuit university hospital. As confirmed in acquired immune-mediated
neuropathies and inherited demyelinating neuropathies peripheral nerves can exhibit
quantifiable enlargement in increased cross-sectional areas (CSA).
We follow up the patient to see improvement and accordingly we see the predictive value of
neuromuscular ultrasound of cranial nerves in Guillain-Barré syndrome