5.6 Guillain-Barre Syndrome

Question 1

Describe the pathophysiology of Guillain-Barre syndrome

Answer 1

• Autoimmune polyradiculoneuropathy (usually demyelinating)
• Known to develop after bacterial/viral infection such as Campylobacter Jejuni (?molecular mimicry)

Question 2

Guillain Barre syndrome involves “segmental demyelination. What is meant by this?

Answer 2

Demyelination that occurs in patches along the axon.

Question 3

What are some sensory/motor features of Guillain Barre in spinal nerves?

Answer 3

• Sensory: loss of sensation (affecting nerves that convey vibration/touch sensation)
• Motor: weakness/areflexia (LMN loss)

Question 4

What are some cranial nerve signs of Guillain Barre syndrome?

Answer 4

• Diplopia
• Difficulty speaking (probably from dysarthria)

Question 5

What are some autonomic signs of Guillain Barre?

Answer 5

• Bowel and bladder issues
• Orthostatic hypotension

Question 6

What are the typical LP findings in Guillain Barre?

Answer 6

• Increased protein
• Normal WBCs

Question 7

Guillain Barre Ix

Answer 7

• Lumbar puncture (?what would you expect)
• Electromyograph
• Pulmonary function tests

Question 8

What are common treatments for Guillain Barre?

Answer 8

• IV immunoglobulins
• Plasmapheresis
• Analgesia

Question 9

Describe the classical history for Guillain Barre

Answer 9

• Ascending weakness/sensory change
• Preceding trigger (e.g. infection)
• Back pain
• Autonomic dysfunction

Question 10

What is the classical triad of Miller Fisher syndrome (which is a subtype of Guillain Barre)?

Answer 10

• Ataxia
• Areflexia
• Opthalmoplegia (eye paralysis)

Question 11

What are some complications of GBS?

Answer 11

• Death (3-4%)
• Exposure keratopathy
• Ongoing motor deficit
• Respiratory failure
• Pneumonia
• Pulmonary embolism (immobilization)

Question 12

At what rate can an axon grow back following axonal GBS?

Answer 12

1mm/day