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Polyradiculoneuritis acuta
Tingling in the feet, then weakness on both sides that rises, and reflexes that vanish early — that belongs in hospital at once, because breathing can be involved.
Also known as: GBS · acute polyradiculoneuritis · ascending paralysis · tingling and weakness in the legs · Miller-Fisher syndrome
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
The body’s own defences attack the sheaths of the nerves outside brain and spinal cord. In about two thirds of cases an infection came one to three weeks earlier — most often diarrhoea caused by Campylobacter, but also influenza, Epstein-Barr, cytomegalovirus; sometimes no trigger can be found. For treatment that matters little; for understanding it matters: the defences fought something and then hit a structure that resembles the germ. The course is typical and therefore recognisable. It nearly always starts with tingling and numbness in the feet, often in the hands too, with back pain that is easily put down to something else. Then comes weakness, symmetrical on both sides and rising from below, and the reflexes disappear early. The peak is usually reached within two weeks, at the latest after four. About a quarter need temporary help with breathing — which is exactly why any suspicion belongs in hospital at once, not under watchful waiting. Treatment is with immunoglobulins or plasma exchange, and the great majority recover largely. But it takes months, not days. Besides breathing, heart rhythm disturbances and strong swings in blood pressure are among the signs that call for monitoring; a simple pointer is whether someone can count from one to twenty in a single breath.
Do not wait and not until tomorrow. The weakness can increase within hours, and treatment works better the earlier it starts.
In hospital the strength of breathing is measured regularly. That is the reason for admission even when someone still looks well — the deterioration comes quietly.
In the spinal fluid the protein rises while the cell count stays normal — often only after some days. An early normal result rules nothing out.
Both are effective and roughly equivalent; which is used depends on availability and condition. Both work best in the first two weeks.
That surprises many, because it works in so many inflammations. In this condition it has not proved useful in trials and is not part of the treatment.
Lying still is what causes clots. Physiotherapy therefore starts early, and prevention runs from the beginning.
Most people become largely well again, but the road takes months to over a year, and lasting tiredness is common. Knowing that early saves much disappointment.
The commonest known trigger — diarrhoea one to three weeks earlier, often only remembered when asked.
Immunoglobulins and plasma exchange work equally well and both only if started within the first two weeks — after that the attack on the nerve sheaths has run its course. Cortisone does not work here; that is the exception among inflammatory nerve conditions. What the treatments do is limit the damage; the recovery is done by the nerve itself, over months up to two years. About eight in ten walk independently again.
About one to two people per hundred thousand are affected each year. In about two thirds an infection precedes it by one to four weeks, most often a Campylobacter diarrhoea. The weakness begins in the legs and rises; the peak is reached at two to four weeks — after that it no longer worsens. About one in four temporarily needs ventilation. Recovery runs over months to two years; in about two in ten a limitation remains.
Tingling, pins and needles, a furry feeling — often in the hands at the same time. This warning sign precedes the weakness by hours to days.
That is what most clearly separates it from a stroke, which hits one side. Here both legs are affected and the weakness travels upwards.
The reflex hammer says more here than any laboratory: absent tendon reflexes with rising weakness are the hallmark.
Usually a bout of diarrhoea or a respiratory infection. People often only remember when asked — it is worth going through the preceding month.
Deep, dragging pain in the back and legs is common and regularly taken for a disc problem — until the weakness appears.
Choking on food, a changed voice, breathlessness while speaking, difficulty breathing when lying flat — then every hour counts.
Rarer, but worth knowing: it starts with double vision, drooping lids and an unsteady gait — not with the feet.
Usually unremarkable. This diagnosis is not made in blood, but from the course, the reflexes, nerve conduction studies and the spinal fluid.
May still be raised from the preceding infection and says nothing about the nerve condition itself.
Measured at the start, because a very low potassium is one of the few causes that look similar and are treated entirely differently.
Without B12 the insulating layer of the nerves is not maintained. A lack causes tingling, numbness and unsteadiness in the dark — and it is one of the few reasons for nerve trouble that can be fully undone if found early.
The nerves cover their energy needs through thiamine. It runs short with alcohol, after stomach operations, with long-lasting vomiting and under water tablets.
Here both count: a lack harms the nerves, and too high an intake over months harms them as well. Supplements therefore belong taken in a dose that has a reason.
Works together with B12. Given alone, folate can improve the blood count while the B12 deficiency goes on damaging the nerves — which is why both are looked at together.
In the recovery phase one lies down for weeks, and bone as well as muscle break down quickly in that time. Vitamin D and protein are the groundwork rehabilitation sits on — they do not speed nerve healing, but they hold what hangs on it.
Not as a treatment but for the distinction: a severe B12 deficiency can make a very similar picture of numbness and unsteady walking, and it is correctable. It belongs measured alongside in every ascending sensory disturbance.
Frequently given during recovery, and harmless at normal dosing. What is to be avoided: high-dose B6 over months — from about 50 mg daily it damages the very nerves that are meant to be healing.
In pregnancy clearly established against neural-tube defects, otherwise mainly with deficiency. Can mask a B12 deficiency — watch both.
Too low sodium occurs often here because the body releases too much ADH. Confusion during the course sometimes comes from that and not from the nerve condition itself — that is treatable.
The condition also affects the nerves that steer pulse and blood pressure. Strong swings — pressure peaks alternating with drops — are the reason there is monitoring and not just observation.
Nerves recover over months, muscles must be rebuilt. 1.2–1.5 g protein per kg a day supports physiotherapy; too little measurably slows it.
Recovery runs over months to two years. Training follows capacity — too much too early leads to a setback that costs weeks.
AWMF 030-130 · S2e · 2026-03 — in force
Therapie immunvermittelter Neuropathien
In addition:
checked 2026-09