GBS

Question 1

What is GBS?

Answer 1

acute inflammatory demyelinating polyneuropathy

Question 2

What do 66% of GBS pts report prior to onset of symptoms?

Answer 2

viral infection

Question 3

What is the cause of the initial myelin destruction?

Answer 3

inflammation due to an autoimmune reaction

Question 4

What is the pathogenesis of GBS?

Answer 4

antibodies penetrate and bind to the antigen on the surface of the myelin
antibody dependent macrophages are activated
macrophages respond to inflammation
attack and destroy myelin between nodes of ranvier
blocks conduction of nerve impulses, schwann cell is primary target of attack

Question 5

What happens after acute polyneuropathy?

Answer 5

after initial demyelination, body initiates repair process
schwann cells divide and remyelinate nerves
recovery is possible because no destruction of cell body or axon
reproduce myelin sheath with a shorter internodal distance

Question 6

What is the secondary process that may happen?

Answer 6

some axons are damaged due to the inflammatory effect
free radicals excreted by macrophages
longer time to heal
possible residual damage - more severe cases

Question 7

How does GBS present in a pt?

Answer 7

varying degree of rapidly ascending, symmetrical muscle weakness, tingling, numbness and pain

Question 8

What is typically the first neurological symptom of GBS?

Answer 8

paresthesia in toes or hands

Question 9

What do reflexes look like in a person with GBS?

Answer 9

severely diminished or absent

Question 10

What are associated ANS issues with GBS?

Answer 10

tachycardia
abnormal cardiac rhythm
BP changes

Question 11

In what pattern does recovery occur in GBS?

Answer 11

proximal to distal

Question 12

What does the acute phase of GBS look like?

Answer 12

onset of symptoms is rapid and progressive and worsens over 24 to 72 hours and continues to progress for days or weeks

Question 13

What is the plateau phase of GBS look like?

Answer 13

symptoms remain for days or a few weeks

Question 14

Describe recovery of GBS.

Answer 14

remyelination and axonal regeneration occurs

can take months to 2 years

Question 15

What is the static phase of GBS?

Answer 15

lasts 2-4 weeks and occurs after progression ceases but before recovery

Question 16

In most cases progression ceases in within ______ weeks.

Answer 16

4

Question 17

What is the most common form of GBS?

Answer 17

Acute inflammatory demyelinating polyneuropathy (AIDP)

Question 18

What is AIDP?

Answer 18

rapid progression with one attack and then a complete recovery

recovery often begins within 3 weeks

Question 19

What is Acute Motor Axonal Neuropathy (AMAN)?

Answer 19

primarily attacks motor nerves

most severe form of GBS

Question 20

What is a possible complication of AMAN?

Answer 20

respiratory failure

Question 21

What is the prognosis for AMAN?

Answer 21

good, but takes longer than AIDP and can have residual deficits

Question 22

What is Acute motor and sensory axonal neuropathy (AMSAN)?

Answer 22

attacks motor and sensory nerves

results in an incomplete recovery

Question 23

What is the hallmark of GBS?

Answer 23

symmetrical loss

Question 24

When must most treatments be given in order to be effective for GBS?

Answer 24

within 1-2 weeks of initial attack

Question 25

____________ are not effective in treating GBS.

Answer 25

oral steroids

Question 26

What is plasmapheresis and what is the PT implication.

Answer 26

removes the damaged antibodies can't treat when the patient is going through this--lasts about a week

Question 27

What treatment blocks the damaged antibodies and has a dose given over 2-5 days?

Answer 27

High Dose Immunoglobulin Therapy - IVIG

Question 28

When would immunosuppressive therapy be indicated?

Answer 28

if pt stays in acute phase too long last resort

Question 29

What are poor prognostic indicators for GBS?

Answer 29

older age at onset protracted time before recovery begins need for ventilation

Question 30

What is myasthenia gravis?

Answer 30

most common disorder of the neuromuscular junction characterized by fluctuating weakness and fatiguability of skeletal muscles

Question 31

What are risk factors for MG?

Answer 31

hx of thymic disorders DM, RA, Lupus chronic infections

Question 32

What is the pathology of MG?

Answer 32

reduction of acetylcholine receptors receptors that remain are flattened results in decreased efficiency of neuromuscular transmission

Question 33

What are early signs of MG?

Answer 33

diplopia (double vision) ptosis

Question 34

What is hallmark of MG?

Answer 34

ptosis

Question 35

What drug is used to diagnose MG?

Answer 35

tensilon - if symptoms improve + diagnosis

Question 36

What is the most reliable and objective diagnostic measure for MG?

Answer 36

EMG testing

Question 37

What are treatments of MG?

Answer 37

ACHe inhibitor medication surgical removal of thymus immmunosuppression

Question 38

How is MG similar to MS?

Answer 38

there are periods of remission/exacerbation but not as noticeable or severe

Question 39

What is Polio?

Answer 39

viral infection that specifically attacks the motor cell bodies

Question 40

What impairments are caused by polio?

Answer 40

asymmetric motor impairments NO sensory loss or change Intact reflexes

Question 41

What is post polio syndrome?

Answer 41

new neuromuscular symptoms that occur decades after recovery from acute paralytic episode this only occurs in muscles that were effected initally