Guillain-Barré Syndrome Eelco F.M. Wijdicks, MD, PhD, Christopher J. Klein, MD  Mayo Clinic Proceedings  Volume 92, Issue 3, Pages 467-479 (March 2017) DOI: 10.1016/j.mayocp.2016.12.002 Copyright © 2016 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 A, George Guillain and Pierre Marie in 1902. B, George Guillain and C, Jean-Alexandre Barré. Mayo Clinic Proceedings 2017 92, 467-479DOI: (10.1016/j.mayocp.2016.12.002) Copyright © 2016 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Current understanding of Guillain-Barré syndrome pathogenesis and clinical variants. In demyelinating Guillain-Barré syndrome, unequivocal antigens have yet to be identified but are inferred by complement activation, myelin destruction, and cleanup by macrophages. In axonal and Miller Fisher variants, specific gangliosides (GM1, GD1a, GQ1b) are targeted by immunoglobulins and share antigenic epitopes with various bacterial and viral antigens. These antigenic targets are at nodal structures, at roots, and located at the end organs. In Miller Fisher syndrome, the GQ1b antigen also exists within the brain stem. In this variant, the macrophages clean up the axon debris and come in from the nodes. Mayo Clinic Proceedings 2017 92, 467-479DOI: (10.1016/j.mayocp.2016.12.002) Copyright © 2016 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 Clinical signs of acute neuromuscular respiratory failure. Mayo Clinic Proceedings 2017 92, 467-479DOI: (10.1016/j.mayocp.2016.12.002) Copyright © 2016 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 4 Suggested triage criteria in hospitalized patients with Guillain-Barré syndrome. IVIG = intravenous immunoglobulin; PF = pulmonary function; 20-30-40 = vital capacity decrease to 20 mL/kg, maximal inspiratory pressure decrease to −30 cm H2O, and maximal expiratory pressure decrease to 40 cm H2O. Mayo Clinic Proceedings 2017 92, 467-479DOI: (10.1016/j.mayocp.2016.12.002) Copyright © 2016 Mayo Foundation for Medical Education and Research Terms and Conditions