Table 2

Comparison of clinical features between Guillain–Barré Syndrome (GBS)10 and paralytic rabies7

GBS10Paralytic rabies7
Features required for diagnosisFour clinical patterns described
1. Progressive weakness of more than one limb1. Paresthaesia and flaccid weakness confined to bitten extremity
2. Areflexia2. Quadriplegic form
3. Resembling transverse myelitis
4. Symmetrical ascending paralysis like GBS
Clinical features supportive of diagnosis
1. Progression over days to 1–4 weeks1. More rapid progression
2. Relative symmetry of neurological deficits2. The extremity with the bite may be more affected
3. Mild sensory symptoms or signs3. Severe paraesthesia, fasciculation and myoedema in the extremity with bite
4. Recovery beginning 2–4 weeks after progression ceases4. Rapidly progressive course with eventual CNS involvement and death; hydrophobia or aerophobia is pathognomonic if present
5. Absence of fever at onset5. Fever is common, during prodromal phase
6. Cranial nerve involvement does occur6. Cranial nerve involvement common as in GBS
7. Autonomic dysfunction common7. Autonomic dysfunction is common as in GBS
Laboratory features supportive of diagnosis
1. Elevated cerebrospinal fluid protein with <10 cells1. Elevated cerebrospinal fluid protein with varying pleocytosis
2. Electrodiagnostic features of nerve conduction slowing or block2. Peripheral nerve demyelination or axonal degeneration