Guillain-Barré Syndrome vs Myasthenia Gravis
Guillain-Barré Syndrome and Myasthenia Gravis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Guillain-Barré Syndrome vs Myasthenia Gravis at a glance
- Guillain-Barré Syndrome: Acute immune-mediated ascending demyelinating polyneuropathy; can cause respiratory failure.
- Myasthenia Gravis: Autoimmune neuromuscular junction disease with fluctuating fatigable weakness.
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Side-by-side comparison
| Feature | Guillain-Barré Syndrome | Myasthenia Gravis |
|---|---|---|
| At a glance | Acute immune-mediated ascending demyelinating polyneuropathy; can cause respiratory failure. | Autoimmune neuromuscular junction disease with fluctuating fatigable weakness. |
| Classic presentation | Acute ascending symmetric weakness + areflexia + antecedent infection + albuminocytologic dissociation in CSF (elevated protein with normal cell count).;… | Fatigable ptosis and diplopia worse at end of day, improving with rest.; Fluctuating, fatigable weakness — worse with use, better with rest; Symptoms… |
| Workup / key labs | Clinical: progressive symmetric weakness + areflexia, peak by 4 weeks, exclusion of alternative causes. Supportive: CSF albuminocytologic dissociation,… | Clinical features + positive antibodies (AChR or MuSK) and/or supportive electrodiagnostics (decremental RNS, abnormal single-fiber EMG).; Acetylcholine… |
| Imaging | MRI spine with gadolinium — exclude compressive lesion; nerve root enhancement (especially cauda equina) supports GBS; Nerve conduction studies / EMG: slowed… | CT chest with contrast (or MRI) — evaluate for thymoma in ALL patients with confirmed MG; Repetitive nerve stimulation: decremental response (>10% drop in… |
| First-line treatment | ICU admission for any patient with autonomic instability, bulbar weakness, or rapidly progressive disease; Frequent pulmonary monitoring (FVC, NIF q4-8h);… | Symptomatic: pyridostigmine (acetylcholinesterase inhibitor) 30-60 mg PO every 4-6 hours, titrate to effect — improves transmission but does not modify… |
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