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Neurology · Ward Pathways · Locked — free with a referral
By Dr Javed Akhtar · Last reviewed 2 October 2026
Presentation Ascending leg weakness over 5 days after diarrhoea; now cannot walk; areflexia; tingling hands; FVC 22 mL/kg
Red flags FVC <20 mL/kg Bulbar weakness Arrhythmia or BP swings Rapid progression Differential diagnosis Transverse myelitis / cord compression (sensory level) Myasthenia gravis Hypokalaemic periodic paralysis Botulism Critical-illness neuropathy Tick paralysis, porphyria, diphtheria When to admit, call ICU or discharge Admit: All with progressive weaknessICU: FVC <20 mL/kg, bulbar or autonomic involvement, rapid progressionIntubate: FVC <15–20 mL/kg, NIF weaker than −20 to −30 cmH₂O, aspirationVentilate: Neuromuscular respiratory failure — avoid suxamethonium (hyperkalaemia)Key points About 25% need ventilation; recovery is usually good but ~5% die (mostly autonomic and respiratory complications). India: axonal variants (AMAN) after Campylobacter are common; small-volume plasma exchange is an option where IVIG is unaffordable. Areflexia with ascending weakness plus back pain is typical; sensory level or early bladder failure suggests a cord lesion instead. Never Give steroids — they do not help GBS Give PLEX followed by IVIG, or switch after one fails Use suxamethonium for intubation Wait for SpO₂ to fall before escalating Common mistakes Steroids Late intubation Missing hypokalaemia or cord compression Ignoring neuropathic pain and DVT prophylaxis Disposition and follow-up HDU/ICU if at respiratory or autonomic risk; neuro-rehabilitation for months.
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