Symptoms of Guillain-Barre get worse very quickly. It may take only a few hours to reach the most severe symptoms.

Muscle weakness or the loss of muscle function (paralysis) affects both sides of the body.  If the muscle weakness starts in the legs and then spreads to the arms, it is called ascending paralysis.

Patients may notice tingling, foot or hand pain, and clumsiness. As the loss of muscle function gets worse, the patient may need breathing assistance.

Typical symptoms include:

• Muscle weakness or loss of muscle function (paralysis)
  • Weakness begins in the feet and legs and may move up to the arms and head
  • May get worse over 24 to 72 hours
  • May start in the arms and move downward
  • May begin in the arms and legs at the same time
  • May occur in the nerves of the head only
  • In mild cases, weakness or paralysis may not occur
• Uncoordinated movement
• Sensation changes
• Numbness, decreased sensation
• Tenderness or muscle pain (may be a cramp-like pain)

Additional symptoms may include:

• Blurred vision
• Difficulty moving face muscles
• Clumsiness and falling
• Palpitations (sensation of feeling heartbeat)
• Muscle contractions

Emergency symptoms (seek immediate medical help):

• Difficulty swallowing
• Drooling
• Difficulty breathing
• Breathing, may temporarily stop
• Can't take a deep breath
• Fainting

A history of increasing muscle weakness and paralysis may indicate Guillain-Barre syndrome, especially if there was a recent illness.

A medical exam may show muscle weakness and problems with involuntary (autonomic) body functions such as blood pressure and heart rate.

There may be signs of decreased breathing (caused by paralysis of the breathing muscles), and a decrease in certain arm and leg reflexes.

The following tests may be ordered:

• NCV (nerve conduction velocity) shows nerve damage.
• EMG  tests the electrical activity in muscles. It may shows that nerves do not react properly to stimulation. 
• CSF (cerebrospinal fluid) may have increased levels of protein without an increase in white blood cells.
• ECG may show heart problems in some cases.

Hughes RA, Raphael JC, Swan AV, van Doorn PA. Intravenous immunoglobulin for Guillain-Barre syndrome. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD002063. Review.

Sharar E. Current therapeutic options in severe Guillain-Barre syndrome. Clin Neuropharmacol. 2006 Jan-Feb;29(1):45-51.

Wiles CM, Brown P, Chapel H, et al. Intravenous immunoglobulin in neurological disease: a specialist review. J Neurol Neurosurg Psychiatry. 2002 Apr;72(4):440-8. Review.

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003: 1085-1090.