Guillain-Barré syndrome complete overview pathophysiology clinical features treatment

"Guillain-Barre syndrome"[MeSH Terms] AND review

mkdir -p /home/daytona/workspace/gbs-clinical-summary && ls /home/daytona/worksp…

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// ══════════════════════════════════════════════════════════════
//  DOCUMENT CONTENT
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// ── TITLE BLOCK ───────────────────────────────────────────────
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    spacing: { before: 0, after: 40 },
    shading: { type: ShadingType.CLEAR, fill: NAVY },
    children: [
      new TextRun({ text: "GUILLAIN-BARRÉ SYNDROME", bold: true, size: 40, color: WHITE, font: "Calibri" }),
    ],
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    spacing: { before: 0, after: 200 },
    shading: { type: ShadingType.CLEAR, fill: NAVY },
    children: [
      new TextRun({ text: "Last reviewed: July 2026  •  Sources: Bradley & Daroff Neurology | Robbins Pathology | Tintinalli EM", size: 16, color: "BFC9CA", font: "Calibri" }),
    ],
  })
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// ─────────────────────────────────────────────────────────────
// 1. DEFINITION & EPIDEMIOLOGY
// ─────────────────────────────────────────────────────────────
children.push(sectionHeading("1. DEFINITION & EPIDEMIOLOGY"));

children.push(
  body("Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy — an inflammatory attack on peripheral nerves and spinal nerve roots causing rapidly progressive weakness, areflexia, and variable sensory loss."),
  body("Most common cause of acute flaccid paralysis in the developed world. Also known as AIDP (Acute Inflammatory Demyelinating Polyradiculoneuropathy) in its classic form.", { bold: false }),
);

// Epi table
children.push(
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    rows: [
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      new TableRow({ children: [dataCell("Annual incidence"), dataCell("1–2 per 100,000")] }),
      new TableRow({ children: [dataCell("Sex ratio", LIGHT_GRAY_BG), dataCell("Male > Female (1.5:1)", LIGHT_GRAY_BG)] }),
      new TableRow({ children: [dataCell("Age <18 yrs"), dataCell("~0.8 per 100,000")] }),
      new TableRow({ children: [dataCell("Age >60 yrs", LIGHT_GRAY_BG), dataCell("~3.2 per 100,000", LIGHT_GRAY_BG)] }),
      new TableRow({ children: [dataCell("Mortality (modern care)"), dataCell("1%–5%")] }),
      new TableRow({ children: [dataCell("Long-term disability", LIGHT_GRAY_BG), dataCell("Up to 20% of hospitalized survivors", LIGHT_GRAY_BG)] }),
      new TableRow({ children: [dataCell("Ventilation required"), dataCell("9%–30% of hospitalized patients")] }),
    ],
  })
);

// ─────────────────────────────────────────────────────────────
// 2. PATHOPHYSIOLOGY
// ─────────────────────────────────────────────────────────────
children.push(sectionHeading("2. PATHOPHYSIOLOGY"));

children.push(
  body("Trigger — Molecular Mimicry:", { bold: true }),
  body("~2/3 of cases are preceded by infection 1–4 weeks prior. Microbial antigens (especially C. jejuni capsular antigens) share structural similarity with peripheral nerve gangliosides (GM1, GD1b). Antibodies formed against the pathogen cross-react with nerve components."),
  body("Immune mechanisms (dual):", { bold: true }),
  bullet("T cell-mediated: Sensitized T cells direct macrophages to invade endoneurium and strip myelin from axons (reproducible in animal models)"),
  bullet("Antibody-mediated (humoral): IgG/IgM antibodies bind nerve antigens → classical complement pathway activation → macrophage processes penetrate Schwann cell basement membrane at nodes of Ranvier → myelin lamellae are physically stripped and engulfed"),
);

children.push(subHeading("Common Triggers"));

children.push(
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      new TableRow({ children: [dataCell("Epstein-Barr Virus"), dataCell("Common trigger")] }),
      new TableRow({ children: [dataCell("Cytomegalovirus (CMV)", LIGHT_GRAY_BG), dataCell("Common trigger", LIGHT_GRAY_BG)] }),
      new TableRow({ children: [dataCell("Mycoplasma pneumoniae"), dataCell("Upper respiratory illness")] }),
      new TableRow({ children: [dataCell("Zika Virus", LIGHT_GRAY_BG), dataCell("Epidemiologically significant", LIGHT_GRAY_BG)] }),
      new TableRow({ children: [dataCell("SARS-CoV-2 / HIV"), dataCell("Reported associations")] }),
      new TableRow({ children: [dataCell("Vaccines (rare)", LIGHT_YELLOW_BG), dataCell("Influenza, VZV, non-mRNA COVID vaccines — rare association", LIGHT_YELLOW_BG)] }),
    ],
  })
);

// ─────────────────────────────────────────────────────────────
// 3. SUBTYPES & VARIANTS
// ─────────────────────────────────────────────────────────────
children.push(sectionHeading("3. SUBTYPES & VARIANTS"));

children.push(subHeading("Common Subtypes"));
children.push(
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    rows: [
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      new TableRow({ children: [
        dataCell("AIDP", LIGHT_BLUE_BG, true),
        dataCell("Demyelinating", LIGHT_BLUE_BG),
        dataCell("Classic form; most common in Europe/North America", LIGHT_BLUE_BG),
      ]}),
      new TableRow({ children: [
        dataCell("AMAN", WHITE, true),
        dataCell("Axonal (motor only)"),
        dataCell("Pure motor paralysis, sensory intact; summer epidemics in China; C. jejuni association"),
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      new TableRow({ children: [
        dataCell("AMSAN", LIGHT_RED_BG, true),
        dataCell("Axonal (motor + sensory)", LIGHT_RED_BG),
        dataCell("Severe; poorest prognosis", LIGHT_RED_BG),
      ]}),
    ],
  })
);

children.push(subHeading("Rare Variants"));
children.push(
  new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
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      new TableRow({ children: [dataCell("Miller-Fisher Syndrome", LIGHT_YELLOW_BG, true), dataCell("Ophthalmoplegia + Ataxia + Areflexia (triad); anti-GQ1b antibodies; 6% of GBS in West", LIGHT_YELLOW_BG)] }),
      new TableRow({ children: [dataCell("Pharyngeal-Cervical-Brachial"), dataCell("Weakness of pharyngeal, cervical, brachial muscles")] }),
      new TableRow({ children: [dataCell("Facial Diplegia with Paresthesias", LIGHT_GRAY_BG), dataCell("Bilateral facial palsy", LIGHT_GRAY_BG)] }),
      new TableRow({ children: [dataCell("Acute Pandysautonomia"), dataCell("Severe autonomic dysfunction")] }),
      new TableRow({ children: [dataCell("Paraparetic Variant", LIGHT_GRAY_BG), dataCell("Predominantly lower limb weakness", LIGHT_GRAY_BG)] }),
    ],
  })
);

// ─────────────────────────────────────────────────────────────
// 4. CLINICAL FEATURES
// ─────────────────────────────────────────────────────────────
children.push(sectionHeading("4. CLINICAL FEATURES"));

children.push(subHeading("Symptom Timeline"));
children.push(
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      new TableRow({ children: [dataCell("Onset"), dataCell("Day 0"), dataCell("Weakness ± paresthesias (often distal hands/fingers)")] }),
      new TableRow({ children: [dataCell("Progression", LIGHT_GRAY_BG), dataCell("Days to 4 weeks", LIGHT_GRAY_BG), dataCell("Ascending paralysis; most reach nadir in <2 weeks", LIGHT_GRAY_BG)] }),
      new TableRow({ children: [dataCell("Plateau"), dataCell("~Week 2–4"), dataCell("Maximum weakness; respiratory risk highest here")] }),
      new TableRow({ children: [dataCell("Recovery", LIGHT_GREEN_BG), dataCell("Weeks to 1 year", LIGHT_GREEN_BG), dataCell("Begins 2–4 weeks after progression stops", LIGHT_GREEN_BG)] }),
    ],
  })
);

children.push(subHeading("Motor"));
children.push(
  bullet("Ascending, fairly symmetric weakness — lower limbs → upper limbs → cranial/oropharyngeal → respiratory muscles"),
  bullet("Areflexia / hyporeflexia — invariable hallmark; may be absent very early"),
  bullet("Cranial nerve involvement in 45%–75%: bilateral facial palsy (>50%), extraocular weakness, dysphagia, dysarthria"),
  bullet("Respiratory failure in 9%–30%; risk ↑ with age"),
);

children.push(subHeading("Sensory"));
children.push(
  bullet("NOT a prominent feature — mostly distal vibration loss"),
  bullet("Pain (moderate–severe) in ~70% during acute phase — extremities, interscapular, back; may persist 1 year"),
  bullet("Dysesthetic pain (burning/tingling) less common"),
);

children.push(subHeading("Autonomic (~65% of hospitalized patients)"));
children.push(
  bullet("Orthostatic hypotension, urinary retention, GI atony"),
  bullet("Sinus tachycardia, tachyarrhythmias, episodic hypertension"),
  bullet("Anhidrosis or episodic diaphoresis, acral vasoconstriction"),
  alertBox("⚠ WARNING:", "Sudden cardiac arrest may occur from excessive vagal activity. Continuous cardiac monitoring is mandatory.", LIGHT_RED_BG, RED),
);

// ─────────────────────────────────────────────────────────────
// 5. DIAGNOSTIC CRITERIA
// ─────────────────────────────────────────────────────────────
children.push(sectionHeading("5. DIAGNOSTIC CRITERIA"));

children.push(
  alertBox("REQUIRED:", "1) Progressive weakness of both legs AND arms (>1 limb)    2) Areflexia or hyporeflexia", LIGHT_BLUE_BG, NAVY),
);
children.push(subHeading("Supportive Clinical Features"));
children.push(
  bullet("Progression over days to 4 weeks"),
  bullet("Relative symmetry of symptoms"),
  bullet("Mild sensory symptoms or signs"),
  bullet("Bifacial palsies"),
  bullet("Autonomic dysfunction"),
  bullet("Absence of fever at onset"),
  bullet("Recovery beginning 2–4 weeks after progression ceases"),
);
children.push(subHeading("Features Against Diagnosis"));
children.push(
  bullet("Persistent marked asymmetry"),
  bullet("Bladder/bowel dysfunction at onset (not later)"),
  bullet("CSF pleocytosis >50 cells/mm³"),
  bullet("Sharp sensory level (suggests cord lesion)"),
);

// ─────────────────────────────────────────────────────────────
// 6. INVESTIGATIONS
// ─────────────────────────────────────────────────────────────
children.push(sectionHeading("6. INVESTIGATIONS"));

children.push(subHeading("CSF Analysis — Albuminocytological Dissociation (Classic Finding)"));
children.push(
  new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({ children: [headerCell("Parameter"), headerCell("Typical GBS Finding"), headerCell("Significance")] }),
      new TableRow({ children: [
        dataCell("Protein", LIGHT_YELLOW_BG, true),
        dataCell(">45 mg/dL (often 100–1000 mg/dL)", LIGHT_YELLOW_BG),
        dataCell("Inflamed root microvasculature → protein leaks", LIGHT_YELLOW_BG),
      ]}),
      new TableRow({ children: [
        dataCell("WBC", WHITE, true),
        dataCell("<10 cells/mm³ (mononuclear)"),
        dataCell("Cells confined to roots, do not enter CSF"),
      ]}),
    ],
  })
);
children.push(
  alertBox("NOTE:", "If WBC >100/mm³, consider: HIV, Lyme, syphilis, sarcoidosis, TB/bacterial meningitis, leukemic infiltration.", LIGHT_YELLOW_BG, TEAL),
);

children.push(subHeading("Electrodiagnostic Studies (EMG/NCS)"));
children.push(
  bullet("AIDP: Reduced conduction velocities, prolonged distal latencies, conduction blocks (demyelination pattern)"),
  bullet("AMAN/AMSAN: Reduced CMAP amplitudes, relatively preserved conduction velocities (axonal pattern)"),
);

children.push(subHeading("Other Tests"));
children.push(
  bullet("MRI: Nerve root enhancement (rules out spinal cord pathology)"),
  bullet("Serology: Anti-GQ1b (Miller-Fisher), Anti-GM1/GD1a (AMAN)"),
  bullet("Nerve biopsy: Mononuclear infiltrate, segmental demyelination and remyelination"),
);

// ─────────────────────────────────────────────────────────────
// 7. TREATMENT
// ─────────────────────────────────────────────────────────────
children.push(sectionHeading("7. TREATMENT"));

children.push(alertBox("⚠ STEROIDS:", "Corticosteroids are NOT beneficial and may be HARMFUL. Do NOT use.", LIGHT_RED_BG, RED));

children.push(subHeading("Step 1 — Respiratory Monitoring (Priority #1)"));
children.push(
  body("Monitor vital capacity (VC). Respiratory failure can occur without dyspnea symptoms — proactive monitoring is essential."),
);

children.push(
  new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({ children: [headerCell("Intubation Indications", RED), headerCell("ICU Admission Criteria (≥4 of:", NAVY)] }),
      new TableRow({ children: [
        dataCell("VC < 15 mL/kg\nPaO₂ < 70 mmHg on room air\nBulbar dysfunction (breathing, swallowing, speech)\nAspiration\nDeclining one-breath count (cannot count 1–25)"),
        dataCell("Cannot stand / lift head / lift elbows\nInsufficient cough\nOnset to admission <7 days\nElevated liver enzymes\nVC < 20 mL/kg\nNIF < −30 cmH₂O\n>30% decline in VC or NIF"),
      ]}),
    ],
  })
);

children.push(
  alertBox("⚠ INTUBATION:", "Avoid SUCCINYLCHOLINE (depolarizing NMB) — risk of severe HYPERKALEMIA due to upregulated acetylcholine receptors in denervated muscle. Use non-depolarizing agents instead.", LIGHT_RED_BG, RED),
);

children.push(subHeading("Step 2 — Immunotherapy"));
children.push(
  new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({ children: [headerCell("Treatment"), headerCell("Mechanism"), headerCell("Adverse Effects"), headerCell("Notes")] }),
      new TableRow({ children: [
        dataCell("IVIg (IV Immunoglobulin)", LIGHT_BLUE_BG, true),
        dataCell("Suppresses immune response; neutralizes pathogenic antibodies", LIGHT_BLUE_BG),
        dataCell("Thromboembolism, aseptic meningitis", LIGHT_BLUE_BG),
        dataCell("More widely available; easier to administer", LIGHT_BLUE_BG),
      ]}),
      new TableRow({ children: [
        dataCell("Plasma Exchange (Plasmapheresis)", WHITE, true),
        dataCell("Directly removes circulating pathogenic antibodies"),
        dataCell("Hemodynamic instability, small ↑ relapse rate"),
        dataCell("Equally effective; full recovery still more likely"),
      ]}),
    ],
  })
);
children.push(
  bullet("Neither IVIg nor plasma exchange is superior to the other"),
  bullet("Combining both offers NO additional benefit"),
);

children.push(subHeading("Step 3 — Supportive Care"));
children.push(
  bullet("Continuous cardiac monitoring (autonomic instability)"),
  bullet("DVT prophylaxis (immobilized patients)"),
  bullet("Nutritional support (NG/PEG if bulbar dysfunction)"),
  bullet("Pain management (neuropathic pain agents: gabapentin, carbamazepine)"),
  bullet("Physical and occupational therapy — start early"),
  bullet("Psychological support (prolonged paralysis is psychologically devastating)"),
);

// ─────────────────────────────────────────────────────────────
// 8. PROGNOSIS
// ─────────────────────────────────────────────────────────────
children.push(sectionHeading("8. PROGNOSIS"));

children.push(
  new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({ children: [headerCell("Outcome"), headerCell("Rate")] }),
      new TableRow({ children: [dataCell("Full/near-full recovery", LIGHT_GREEN_BG, true), dataCell("~80%", LIGHT_GREEN_BG)] }),
      new TableRow({ children: [dataCell("Mortality (respiratory failure, autonomic instability, cardiac arrest)"), dataCell("2%–5%")] }),
      new TableRow({ children: [dataCell("Long-term disability (hospitalized survivors)", LIGHT_YELLOW_BG), dataCell("Up to 20%", LIGHT_YELLOW_BG)] }),
      new TableRow({ children: [dataCell("Relapse rate"), dataCell("~3%")] }),
    ],
  })
);

children.push(subHeading("Poor Prognostic Factors"));
children.push(
  bullet("Older age"),
  bullet("Rapid progression to nadir"),
  bullet("Need for mechanical ventilation"),
  bullet("AMSAN subtype"),
  bullet("Very low CMAP amplitudes on NCS"),
  bullet("Preceding C. jejuni infection"),
);

// ─────────────────────────────────────────────────────────────
// 9. DIFFERENTIAL DIAGNOSIS
// ─────────────────────────────────────────────────────────────
children.push(sectionHeading("9. DIFFERENTIAL DIAGNOSIS"));

children.push(
  new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({ children: [headerCell("Condition"), headerCell("Distinguishing Feature")] }),
      new TableRow({ children: [dataCell("Myasthenia Gravis"), dataCell("Fatigability, normal reflexes early, ptosis/diplopia, anti-AChR antibodies")] }),
      new TableRow({ children: [dataCell("Transverse Myelitis", LIGHT_GRAY_BG), dataCell("Spinal level, early bladder/bowel, MRI cord lesion", LIGHT_GRAY_BG)] }),
      new TableRow({ children: [dataCell("Botulism"), dataCell("Descending paralysis, dilated fixed pupils, food/wound exposure, no sensory loss")] }),
      new TableRow({ children: [dataCell("Tick Paralysis", LIGHT_GRAY_BG), dataCell("Ascending paralysis — but tick found on scalp", LIGHT_GRAY_BG)] }),
      new TableRow({ children: [dataCell("Poliomyelitis"), dataCell("Fever, CSF pleocytosis, asymmetric weakness, no sensory symptoms")] }),
      new TableRow({ children: [dataCell("Hypokalemic Periodic Paralysis", LIGHT_GRAY_BG), dataCell("Low K⁺, episodic, no sensory signs", LIGHT_GRAY_BG)] }),
      new TableRow({ children: [dataCell("Lyme Neuroborreliosis"), dataCell("Tick exposure, erythema migrans history, facial palsy, positive serology")] }),
      new TableRow({ children: [dataCell("Critical Illness Polyneuropathy", LIGHT_GRAY_BG), dataCell("ICU setting, preceded by sepsis/MODS", LIGHT_GRAY_BG)] }),
      new TableRow({ children: [dataCell("Diphtheria"), dataCell("Palatal palsy first, pharyngeal membrane, history of incomplete vaccination")] }),
    ],
  })
);

// ─────────────────────────────────────────────────────────────
// 10. GBS vs CIDP
// ─────────────────────────────────────────────────────────────
children.push(sectionHeading("10. GBS vs CIDP — Key Differences"));

children.push(
  new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({ children: [headerCell("Feature"), headerCell("GBS (Acute)"), headerCell("CIDP (Chronic)")] }),
      new TableRow({ children: [dataCell("Time course"), dataCell("Nadir ≤4 weeks"), dataCell("Progresses >2 months")] }),
      new TableRow({ children: [dataCell("Course", LIGHT_GRAY_BG), dataCell("Monophasic", LIGHT_GRAY_BG), dataCell("Relapsing-remitting or progressive", LIGHT_GRAY_BG)] }),
      new TableRow({ children: [dataCell("Sensory involvement"), dataCell("Minor"), dataCell("Prominent mixed sensorimotor")] }),
      new TableRow({ children: [dataCell("Associations", LIGHT_GRAY_BG), dataCell("Preceding infection", LIGHT_GRAY_BG), dataCell("Paraproteinemia, lymphoma, HIV", LIGHT_GRAY_BG)] }),
      new TableRow({ children: [dataCell("Steroids"), dataCell("NOT effective — may harm"), dataCell("Effective (ongoing)")] }),
    ],
  })
);

// ─────────────────────────────────────────────────────────────
// 11. QUICK REFERENCE MNEMONICS
// ─────────────────────────────────────────────────────────────
children.push(sectionHeading("11. QUICK REFERENCE MNEMONICS"));

children.push(
  new Paragraph({
    spacing: { before: 80, after: 60 },
    shading: { type: ShadingType.CLEAR, fill: LIGHT_BLUE_BG },
    border: { left: { style: BorderStyle.SINGLE, size: 16, color: NAVY, space: 8 } },
    indent: { left: 240 },
    children: [
      new TextRun({ text: "GBS CORE FEATURES: ", bold: true, size: 20, color: NAVY, font: "Calibri" }),
      new TextRun({ text: "Ascending weakness + Areflexia = GBS until proven otherwise", size: 20, color: DARK, font: "Calibri" }),
    ],
  }),
  new Paragraph({
    spacing: { before: 60, after: 60 },
    shading: { type: ShadingType.CLEAR, fill: LIGHT_GREEN_BG },
    border: { left: { style: BorderStyle.SINGLE, size: 16, color: TEAL, space: 8 } },
    indent: { left: 240 },
    children: [
      new TextRun({ text: "TREATMENT: ", bold: true, size: 20, color: TEAL, font: "Calibri" }),
      new TextRun({ text: "IVIg OR Plasma Exchange + Supportive care. NEVER steroids.", size: 20, color: DARK, font: "Calibri" }),
    ],
  }),
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    spacing: { before: 60, after: 60 },
    shading: { type: ShadingType.CLEAR, fill: LIGHT_RED_BG },
    border: { left: { style: BorderStyle.SINGLE, size: 16, color: RED, space: 8 } },
    indent: { left: 240 },
    children: [
      new TextRun({ text: "DANGER: ", bold: true, size: 20, color: RED, font: "Calibri" }),
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    indent: { left: 240 },
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      new TextRun({ text: "CSF: ", bold: true, size: 20, color: "#B7950B", font: "Calibri" }),
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    shading: { type: ShadingType.CLEAR, fill: LIGHT_GRAY_BG },
    border: { left: { style: BorderStyle.SINGLE, size: 16, color: MID, space: 8 } },
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    children: [
      new TextRun({ text: "MILLER-FISHER: ", bold: true, size: 20, color: MID, font: "Calibri" }),
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// ─────────────────────────────────────────────────────────────
// FOOTER NOTE
// ─────────────────────────────────────────────────────────────
children.push(
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    alignment: AlignmentType.CENTER,
    spacing: { before: 200, after: 40 },
    border: { top: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA", space: 8 } },
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      new TextRun({ text: "Sources: Bradley & Daroff's Neurology in Clinical Practice | Robbins & Cotran Pathologic Basis of Disease | Robbins & Kumar Basic Pathology | Tintinalli's Emergency Medicine", size: 15, color: "888888", font: "Calibri", italics: true }),
    ],
  }),
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    alignment: AlignmentType.CENTER,
    spacing: { before: 0, after: 0 },
    children: [
      new TextRun({ text: "EAN/PNS GBS Guideline 2023 (PMID: 37814552) | Bellanti & Rinaldi Comprehensive Review 2024 (PMID: 38813755)", size: 15, color: "888888", font: "Calibri", italics: true }),
    ],
  }),
);

// ══════════════════════════════════════════════════════════════
//  BUILD DOCUMENT
// ══════════════════════════════════════════════════════════════

const doc = new Document({
  styles: {
    default: {
      document: {
        run: { font: "Calibri", size: 20 },
      },
    },
  },
  sections: [
    {
      properties: {
        page: {
          margin: { top: 720, bottom: 720, left: 900, right: 900 },
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      },
      footers: {
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Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync("/home/daytona/workspace/gbs-clinical-summary/GBS_Clinical_Quick_Reference.docx", buffer);
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cd /home/daytona/workspace/gbs-clinical-summary && node create_gbs_doc.js 2>&1

python3 /home/daytona/skills/docx/scripts/office/validate.py /home/daytona/works…

cd /home/daytona/workspace/gbs-clinical-summary && python3 -c " import zipfile, …

A clean, professional clinical flowchart for Guillain-Barré Syndrome (GBS) diagnosis and management. White background, medical style. The flowchart flows top to bottom with color-coded boxes and arrows. TITLE at top: "GUILLAIN-BARRÉ SYNDROME: Diagnosis & Management Flowchart" in bold dark navy. STEP 1 - TRIGGER (light blue box): "Antecedent Event (1-4 weeks prior)" with sub-text: "Campylobacter jejuni | CMV | EBV | Mycoplasma | Zika | SARS-CoV-2 | Vaccination (rare)" Arrow pointing down. STEP 2 - PRESENTATION (light blue box): "Clinical Presentation" with bullet points: "• Ascending symmetric weakness (legs → arms → cranial)" "• Areflexia / Hyporeflexia (hallmark)" "• ± Sensory paresthesias" "• ± Autonomic dysfunction" "• ± Facial palsy (bilateral)" Arrow pointing down. STEP 3 - DIAGNOSTIC CRITERIA (navy box, white text): "Diagnostic Criteria REQUIRED:" "✓ Progressive weakness >1 limb" "✓ Areflexia / Hyporeflexia" Supportive: "Symmetry | Mild sensory signs | Cranial palsy | No fever at onset" Arrow splits into TWO paths labeled "INVESTIGATE": LEFT PATH - CSF Analysis (yellow box): "Lumbar Puncture" "↑ Protein (>45 mg/dL)" "↓ Cells (<10/mm³)" "= Albuminocytological Dissociation" RIGHT PATH - NCS/EMG (yellow box): "Nerve Conduction Studies" "AIDP: ↓ Conduction velocity" "AMAN: ↓ CMAP amplitude" "AMSAN: Severe axonal damage" Both paths merge with arrow down. STEP 4 - SUBTYPES (three colored boxes side by side): - GREEN box: "AIDP - Demyelinating - Most common West" - ORANGE box: "AMAN - Axonal/Motor - Common Asia" - RED box: "AMSAN - Axonal Motor+Sensory - Worst prognosis" Small box below: "Miller-Fisher Variant: Ophthalmoplegia + Ataxia + Areflexia (Anti-GQ1b +)" Arrow down labeled "MANAGEMENT" STEP 5 - IMMEDIATE (red bordered box): "⚠ RESPIRATORY MONITORING (Priority #1)" "Vital Capacity < 15 mL/kg → INTUBATE" "⚠ AVOID SUCCINYLCHOLINE → Hyperkalemia risk" "Admit to ICU if ≥4 risk criteria met" Arrow down. STEP 6 - TREATMENT (two green boxes side by side): LEFT: "IVIg 0.4 g/kg/day × 5 days" RIGHT: "Plasma Exchange 5 sessions" Center text below boxes: "EQUALLY EFFECTIVE — Do NOT combine — No additional benefit" Red warning box: "✗ NO STEROIDS — Not effective, may harm" Arrow down. STEP 7 - SUPPORTIVE CARE (light green box): "• Cardiac monitoring (autonomic storms)" "• DVT prophylaxis" "• Pain management (gabapentinoids)" "• Nutritional support" "• Physiotherapy" Arrow down. STEP 8 - PROGNOSIS (split into three colored outcome boxes): - Green: "~80% Full Recovery" - Yellow: "~20% Long-term Disability" - Red: "2-5% Mortality (respiratory/autonomic)" Clean arrows throughout, professional medical typography, well-spaced layout.