Guillain–Barré syndrome

Weakness and reflex trajectory

Record the distribution, symmetry and evolution of weakness alongside reflex examinations.

1. When did neurological symptoms and objective weakness begin, and how certain are those dates? provenance
2. Which limbs and cranial functions are affected, and what reflex findings were recorded at each examination? measurement
3. Does the observed progression fit the diagnostic framework being applied? boundary

Variant assignment

Record the proposed clinical phenotype and the observations supporting it.

1. Which clinical phenotype best describes the episode, including ophthalmoplegia, ataxia or regional weakness? definition
2. Which expected features are absent, unexamined or inconsistent with that assignment? boundary

Competing localizations

Keep clinically consequential alternatives and their discriminating evidence explicit.

1. What evidence favors spinal cord disease, neuromuscular junction disease, myopathy or another neuropathy? boundary
2. Which unresolved alternative requires urgent investigation or specialist review? action

CSF interpretation

Represent protein and cell-count results as separate observations.

1. What were CSF protein and white-cell count, with units, reference ranges and day from onset? measurement
2. How did the clinician interpret these results, including possible alternative explanations? provenance

Electrodiagnostic interpretation

Retain study findings, classification criteria and revisions across serial studies.

1. Which nerves and parameters were examined, and what classification did the report support? measurement
2. Is the study sufficiently informative, or has the clinician requested repeat testing? action

Criteria-based assessment

Keep clinical judgment and formal case-definition classification separately attributable.

1. Which criteria and version were applied, and which elements are satisfied, missing or contradicted? definition
2. Who made the diagnostic assessment, when, and from which examination and investigation reports? provenance

Antecedent and targeted evidence

Record preceding illness and selectively requested tests without assigning unsupported causation.

1. Which antecedent infections or exposures are documented, and by history or testing? provenance
2. What diagnostic uncertainty would antibody testing, imaging or another targeted investigation resolve? action

Respiratory trend

Combine serial respiratory measurements with observed effort and current support.

1. How are vital capacity, respiratory pressures and breathing effort changing, and are measurements reliable? measurement
2. Which clinician-approved escalation criteria are met, and has the responsible team been notified? action

Airway protection

Record swallowing, cough and secretion management independently of walking ability.

1. What assessment establishes current swallowing safety, cough effectiveness and secretion handling? measurement
2. What airway, nutrition or swallowing review is required by the documented findings? action

Autonomic instability

Capture autonomic events, their timing and alternative explanations.

1. Which rhythm disturbances, blood-pressure changes or bowel/bladder abnormalities have been observed? measurement
2. What monitoring or escalation plan addresses these events, and which competing causes remain under review? action

Motor disability trend

Track strength and practical function using comparable assessments.

1. What are the current muscle grades, GBS disability grade and actual walking or transfer abilities? measurement
2. Which changes reflect neurological deterioration rather than pain, sedation or another limitation? boundary

Immunotherapy decision

Record the indication, selected option and reason for the decision.

1. How do onset timing, walking ability and current progression inform IVIg or plasma-exchange consideration? action
2. Which contraindications, patient preferences and service constraints influenced the clinician's decision? provenance
3. Which guideline version and patient-population assumptions support that decision? provenance

Course completion and effects

Link treatment delivery, interruptions and adverse events to serial assessments.

1. What treatment was actually delivered, on which dates, and with what interruptions or adverse events? provenance
2. What objective changes followed treatment, and what prevents attributing those changes to treatment alone? measurement

Post-treatment deterioration

Represent renewed worsening without assuming that additional immunotherapy is appropriate.

1. Did deterioration follow documented improvement or stabilization, and at what intervals from onset and treatment? measurement
2. What specialist review is needed to distinguish ongoing progression, treatment-related fluctuation, complication or another diagnosis? action

Recovery profile

Record neurological recovery and patient-experienced limitations separately.

1. Which weakness, sensory symptoms, pain, fatigue or autonomic problems persist at each follow-up? measurement
2. How do those problems affect self-care, mobility, communication, work or education compared with baseline? measurement

Rehabilitation goals

Link the current recovery profile to agreed support and reassessment.

1. Which rehabilitation goals and supports have the patient and clinical team agreed? action
2. What observations will justify increasing, modifying or reducing support? action

Qualified prognosis

Record predictions with their inputs, intended outcome and applicability limits.

1. If a prognostic score is used, which version, input dates and outcome horizon produced the estimate? provenance
2. Does its validation population match this patient's age, phenotype and care setting? boundary

Episode reclassification

Keep the original assessment and the reasons for any later revision traceable.

1. Does the duration or pattern of renewed worsening require review for acute-onset CIDP, recurrent GBS or another explanation? boundary
2. Who authorized a revised diagnosis, on what evidence, and which treatment or follow-up decisions changed? provenance

Kinds and varieties

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

• Acute inflammatory demyelinating polyradiculoneuropathy (AIDP)
• Acute motor axonal neuropathy (AMAN)
• Acute motor-sensory axonal neuropathy (AMSAN)
• Miller Fisher syndrome (MFS)
• Bickerstaff brainstem encephalitis (BBE)
• Pharyngeal-cervical-brachial (PCB) variant
• Paraparetic GBS
• Acute pandysautonomia

1. Which of these kinds and varieties hold for the sense of Guillain-Barré syndrome this model covers, and on what evidence? provenance