6.8 Guillain Barré Syndrome Flashcards
Q8 — Guillain-Barré syndrome
A 68-year-old man is referred to the neurointensive care unit with suspected Guillain-Barré syndrome.
a) What is Guillain-Barré syndrome (GBS) and what are its causes?
Guillain-Barré syndrome (GBS) is:
● An acute demyelinating polyneuropathy.
● An autoimmune response following a gastrointestinal or respiratory tract infection.
● Characterised by areflexia,
motor weakness and
CSF abnormalities.
Causes of GBS:
● Gastrointestinal or respiratory infection with pathogens such as
Campylobacter jejuni, Epstein-Barr virus, Mycoplasma pneumoniae and Cytomegalovirus.
● As a complication of HIV infection.
● Other associations such as vaccines, surgery, epidural anaesthesia, bone marrow and organ transplant, SLE, lymphoma, sarcoidosis.
b) List the clinical features of GBS.
● Motor weakness, progressive and usually ascending.
● Areflexia.
● Bulbar weakness and facial palsy.
● Ophthalmoplegia.
● Severe pain.
● Sensory involvement and symptoms.
● Respiratory muscle weakness leading to respiratory failure.
● Autonomic dysfunction leading to arrhythmias, labile blood pressure, fluctuations in heart rate, urinary retention, increased sweating and ileus.
c) List the investigations/findings that can be used to aid the
diagnosis.
● Routine blood tests —
FBC, urea and electrolytes, liver function tests,
renal function tests, clotting screen, calcium,
inflammatory markers.
● Antibody tests
to detect antiganglioside antibodies which are
associated with a poorer prognosis.
It is possible to also detect
antibodies to the causative organism.
● Blood cultures.
● Stool cultures —
to detect a Campylobacter infection.
● ECG —
may show evidence of arrhythmias, ST depression,
T wave inversion and a prolonged QT interval.
● CT of the head —
to exclude raised intracranial pressure before
performing a lumbar puncture.
● Lumbar puncture and CSF analysis —
typically, increased protein and cells <10/mm2.
● Electrophysiological studies —
to aid the diagnosis and help differentiate
from other conditions such as critical illness
polyneuropathy.
● Gadolinium-enhanced spinal MRI.
d) What supportive treatment is needed in this patient with GBS?
● Counselling.
● Nutritional support and dietetic input.
● Analgesia.
● Thromboembolic prophylaxis.
● Respiratory support.
● Physiotherapy and occupational therapy.
e) What specific therapies are available for GBS?
● Intravenous immunoglobulins.
● Plasma exchange.
● Corticosteroids.
● CSF filtration.
