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Guillain-Barré syndrome with respiratory and autonomic involvement — SCE Acute Medicine MCQ

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HardNeurology and ophthalmologyGuillain-Barré syndrome with respiratory and autonomic involvementSCE Acute Medicine

A 58-year-old man presents with 5 days of ascending leg weakness after diarrhoea. Examination shows areflexia, bifacial weakness and reduced cough. Forced vital capacity is 14 mL/kg and sodium is 128 mmol/L. ECG shows labile heart rate between 45 and 130/min. What is the most appropriate next step in management?

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Correct answer: D — Admit to critical care for respiratory and autonomic monitoring and start immunotherapy

Guillain-Barré syndrome with low vital capacity, bulbar weakness and autonomic instability requires critical care monitoring and IVIG or plasma exchange. Steroids are not effective treatment for GBS. Nerve conduction studies support diagnosis but must not delay escalation in a patient at risk of respiratory failure.

Reference: Association of British Neurologists Guillain-Barré guidance; NICE CKS Guillain-Barré syndrome