Chart — Neurology
Myasthenia Gravis vs Guillain-Barré Chart
Two neuromuscular diseases that move in opposite directions — MG descends and fatigues, GBS ascends with lost reflexes — and meet at the same emergency when the weakness reaches the diaphragm.
Educational use only. Crisis and immunotherapy management are specialist-directed; escalate respiratory decline early in both diseases. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Side by Side
| Feature | Myasthenia gravis | Guillain-Barré |
|---|---|---|
| What's wrong | Antibodies block acetylcholine receptors at the neuromuscular junction | Autoimmune demyelination of peripheral nerves |
| Direction of weakness | DESCENDING — eyes/face first, then down | ASCENDING — feet/legs up toward the trunk |
| Hallmark feature | Fatigability — worse with use, better with rest | Symmetric weakness + AREFLEXIA (lost deep tendon reflexes) |
| Onset / trigger | Chronic; flares with infection, stress, surgery, certain drugs | Acute, 1–3 weeks AFTER a respiratory or GI infection |
| First signs | Ptosis, diplopia, then bulbar weakness | Leg weakness/paresthesias ascending, with pain |
| Course | Chronic with exacerbations; crises possible | Ascends over days, plateaus, then recovers (usually well) |
| Treatment | Pyridostigmine, immunosuppression, thymectomy; IVIG/PLEX in crisis | IVIG or plasmapheresis (NOT anticholinesterases or steroids) |
| Shared danger | Respiratory muscle weakness → failure | Respiratory failure + autonomic instability |
Exam Traps
- ✦MG = DESCENDING + fatigable (ptosis/diplopia first); GBS = ASCENDING + areflexia after an infection.
- ✦Both threaten the airway — monitor FVC/NIF; a falling vital capacity warns before SpO₂ falls.
- ✦MG treatment is pyridostigmine (give on time, before meals); GBS treatment is IVIG or plasmapheresis.
- ✦Anticholinesterases and steroids do NOT treat GBS.
- ✦GBS adds autonomic instability (BP swings, arrhythmias) — continuous cardiac monitoring.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Heart Association / American Stroke Association (AHA/ASA) · American Association of Neuroscience Nurses (AANN). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →