Acute immune-mediated polyradiculoneuropathy causing ascending flaccid weakness and areflexia, usually post-infectious.
Clinical features
- • Ascending symmetrical weakness over days
- • Areflexia
- • Neuropathic pain, paraesthesia
- • Autonomic instability
Investigations
- • CSF albuminocytological dissociation (may be normal in first week)
- • Nerve conduction studies
- • Serial FVC and negative inspiratory force
- • Anti-ganglioside antibodies (Miller Fisher: anti-GQ1b)
Management
- • IVIG 0.4 g/kg/day × 5 days OR plasma exchange (equivalent)
- • ICU if FVC <20 mL/kg, MIP <30, bulbar failure (20/30/40 rule)
- • VTE prophylaxis, pain control (gabapentin), physiotherapy
Clinical pearls
- • Steroids alone are ineffective
- • Autonomic dysfunction can cause fatal arrhythmia — cardiac monitoring
Related in WardRound
Educational — verify locally.
