THE PROGNOSTIC SIGNIFICANCE OF THE "GUILLAIN-BARRÉ SYNDROME"

Abstract

A group of 22 cases of polyradicular neuritis with albumino-cytologic dissociation and non-fatal outcome is presented to indicate that the course and clinical features of the disease may be of value in determining the prognosis. The occurrence of remissions and exacerbations is described, the latter having been considered unusual in inflammatory disease. Etiological relationships with tonsillitis, exudative pharyngitis of streptococci or diphtheritic origin and pyemia are discussed. Evidence is presented that the use of sulfonamides in the treatment of primary infections may constitute the etiological agent on occasion. It is indicated that central nervous system involvement is masked by disease of the peripheral nerves so that the former may be predicated but not proved. Albumino-cytologic dissociation in this syndrome is the prominent differentiating feature of the disease. Conditions due to toxins show little or no alteration in protein content of the cerebral spinal fluid. Treatment has been palliative and empirical. Most important is the prevention of complications due to swallowing, respiratory and bladder disfunction. The disease is self limited and improves despite a lack of specific treatment. Death was narrowly averted in 2 cases of the series. It is suggested that it may be possible to avoid fatalities in cases with swallowing or respiratory difficulties by providing tube feeding, artificial respiration and bronchoscopy. Because the lesions were not within the brain stem in the near fatal cases, these could be successfully tided over the paralytic phase by unremitting nursing care. In true bulbar involvement such measures are usually futile.