Guillain-Barré syndrome, case studies and questionnaire to illustrate junior doctors' awareness of muscle strength...

Three patients, aged 7-15 years, with Guillain-Barré syndrome presented with pain as the primary complaint. Two did not complain of weakness and their progressive loss of function was incorrectly ascribed to the pain. One did complain of weakness, in association with flu-like symptoms, but the significance of the complaint was not appreciated. At diagnosis all three had profound, predominantly proximal weakness. We believe the delayed diagnosis relates to doctors' lack of opportunity to examine patients with muscle weakness. We conducted a questionnaire survey of junior hospital doctors asking them about their hands-on experience of testing muscle strength and about their knowledge of the Medical Research Council (MRC) Scale of muscle strength. Doctors who claimed most experience did not have a better knowledge of the MRC scale. We recommend doctors-in-training should be given more opportunity to examine patients with muscle weakness and should be made familiar with a clinical scale of muscle strength.