8. Guillain-Barré Syndrome

Question 1

Clinical features

Answer 1

1. Prodrome
   Camplybacter jej / myocplasma pneumoniae / cmv / ebv / vaccine / major surgery

Progressing ascending
symetrical limb weakness

distal paraesthesia / pain / sensory loss

Reduced / absent reflexes

Nerve Palsies
FN/bulbar nerve

Respiratory muscle involvement
ultimately may req IPPV

Autonomic dysfunction
Tachycardiac / Arrhy
diaphoresis / retention

** Miller Fischer Syndrome / Variant

Question 2

Invx

Answer 2

reg assess Vital capacity
CCM if <20mL/kg

CSF
Protein ↑
WCC normal

Nerve conduction study
distinguish axonal damage vs demyelination

MRI brain & S.Cord

Bloods
Antiganglioside autoantibody
antibody & serology
C jej / m. pneum / ebv / hsv / hiv / hep a-c / atypical

TFT B12 Folate paraprotein bands

Stool
C Jej / Polio / porphyria’s

Question 3

Management

Answer 3

T/F to CCM
Resp compromise
Bulbar involvements
autonomic instability

Question 4

a/B

Answer 4

A/B
VC <15mL/kg - I+V
Sux c/i - fatal hyperK
Consider early trach 
- likely long wean

Question 5

C

Answer 5

Caution w/ CVS instabilit during induction for I+V
autonomic dyfxn

CVS support require?
pacing for rx resistant brady

Question 6

D

Answer 6

IV IG
400mg/kg OD x5/7

PLEX 400ml/Kg
3-5 Rx over 1/52

Early physio
flexion contractures / pressure sores / nerve palsies

Psych input
cognitive disturb
depression

** steroids no longer used - some books still talk about pulsed dose methylpred

Question 7

Rx other

Answer 7

VTE proph

Early Enteral feeding
parenterally if ileus

Stress ulcer proph

Analgesia
Neuropathic analgesics
gabapentin
amitryp

Question 8

Prognosis

Answer 8

Approximately 80 percent of patients are able to walk independently and more than half recover completely by one year. However, severe motor impairments persist in more than 10 percent