GBS vs Critical Illness Neuropathy

• GBS and CIP are important causes of weakness in ICU and distinguishing between them is important due to the management and prognostic implications

COMPARISON

	GBS	CIP
History	Recent GI or resp illness. Progressive bilateral symmetric paralysis. Subtypes can be more localized e.g. MF opthalmoplegia and ataxia. Sensory involvement is common. Areflexic. Autonomic involvement may be present	Always occurs in association  with a critical illness in particular severe sepsis. May have an association with encephalopathy in early stages. It is a symmetrical weakness. May have muscle tenderness, hyporeflexic, diminished distal sensation Not associated with autonomic involvement
Examination	Albuminocytologic dissociation in CSF. Identification of infection with campylobacter, mycoplasma, EBV,Varicella, CMV. Elevated csf IGG levels and possible serum antiganglioside antibodies	Elevated CK which may be transient.
Investigations	When demyelinating form is present, you get a reduction in conduction velocity as well as reduction in CMAP In axonal forms however it is  only the distribution of the findings that helps determine the diagnosis	A axonal neuropathy resulting in a decreased CMAP without a reduction in conduction velocity