13) GBS Flashcards
GBS
Autoimmune disorder characterized by antibody-mediated demyelination
Why is the fact that schwann cells are spared w/GBS a good thing?
Allows for future recovery & re-myelinization
GBS is the most common cause of what?
- Rapidly evolving motor paresis
- Paralysis
- Sensory deficits
What pop is GBS most common in?
Male young adults & people btwn ages 50-80
Sx’s of GBS
- Flaccid paralysis
- Areflexia
- Respiratory compromise
- Autonomic dysfxn
Explain the pathogensis of GBS
- Schwann cells get attacked by the immune system
- Inflammatory response is initiated–>Lymphocytes & macrophages
- Macrophages strip myelin starting at the node of ranvier
- Schwann cells divide & remyelinate nerves
W/flaccid paralysis, when does max weakness occur?
2-3wks after onset
What occurs in 50% of cases of fllaccid paralysis
Muscle weakness
What can pharyngeal & laryngeal weakness cause?
Dysphagia & subsequent aspiration
What occurs w/autonomic dysfxn?
- BP & HR fluctuations
- Excessive/No sweating
- Flusing of face
Classic GBS (AIDP)
Acute Inflammatory Demyelinating Polyrediculoneuropathy
Describe the devo & progression of sx’s of AIDP
Fast from distal to proximal in a “stocking glove” manner
What other patho’s need to be r/o when dx’ing AIDP?
- NMJ Pathos
- Tick neuropathy
- Toxic neuropathy
- Myasthenia gravis
- Neuromuscular blocking agents
- CNS Pathos
- Transverse myelitis
- ASA syndrome
- Polio
- CVA
- Metabolic disoders
NIH Criteria for Dx of GBS
- Progressive, symmetric weakness in >1 limb
- Loss of DTR
- Sensory deficitd
- Decr NCV
- Tachycardia
- Arrythmia
- Labile BP
- 1wk LP w/incr albumin & decr WBC
- No fever
Is GBS a medical emergency?
Can be
Medical Management of GBS
- Tx aimed at controlling the autoimmune response
- Plasmapheresis to decr time on vent
- IVIg
Are corticosteroids effective for tx’ing GBS?
No
When does recovery of GBS begin?
2-4wks after peak impairment
What is the static phase?
Time between peak impairment & recovery
How does GBS recovery occur?
From proximal to distal
How long does GBS recovery take?
Wks to yrs
Factors for a Good Prognosis
- Younger age at onset
- Shorter static phase
- Inact axons
- Less total impairment
- No need for mechanical ventilation
Factors for Poor Prognosis
- Advanced age at onset
- Longer static phase
- Need for mechanical vent
- Evidence of axonal degeneration
AMAN
Acute Motor Axonal Neuropathy
AMSAN
Acute Motor & Sensory Axonal Neuropathy
Acute Autonomic Neuropathy
Postural hypotension, impaired sweating, & impaired B&B
CIDP
Chronic Inflammatory Demyelinating Polyneuropathy
Chronic Inflammatory Demyelinating Polyneuropathy
Chronic counterpart to GBS, but sx’s are more difuse, progression is slower, & can relapse-remit
Who is CIDP more commonly dx’ed in?
Women & Young adults
If GBS goes un-dx’ed, what can happen?
Severe permanent nerve damage
Tx for GBS
Corticosteroids w/ or w/o immunosuppressants
Long-term consequences of GBS tx
- Mood swings
- Fluid retention
- Incr BP
- Fx
- OP
- Bruising
- Glaucoma
- Weight gain
- Incr infection risk
Acute management of GBS
- Skin care & positioning
- ROM–>Splinting to prevent contractures
- Respiratory management
- Progress fxnl mobility
- Pt & family ed
What does rehab consist of?
- Regain independence
- Continue w/fxnl mobility
- W/c mobility
- Gait training w/BW support system or orthotics
- Balance training
- TherEx
- Aquatic Therapy
Is NMES effective & why?
No bc of demyelination
