GBS

Question 1

etiology?

Answer 1

Hx of respiratory or GI symptoms up to 6 weeks prior to onset of GBS

associated pathogens:
-campylobacter jejuni (campylobacter enteritis) is the most common pathogen. present with fever, bloody diarrhea, abdomen pain
-influenza, sars-cov2
-EBV, CMV

also associated with vaccinations

Question 2

pathophysiology?

Answer 2

autoimmune-mediated demyelination of motor and sensory fibers of PERIPHERAL NERVES and cranial nerves (CN3 to CN12)

molecular mimicry is involved if its post-infectious

Question 3

typical disease progression and symptoms?

Answer 3

its acute/subacute and peaks at 2-4 weeks, plateaus for months to years until partial or complete recovery

1. ASCENDING bilateral flaccid paralysis, paresthesia (stock and glove distribution: means pins and needles sensation distributed only around hands and feet not extending beyond the wrist or ankles), hyporeflexia
2. cranial nerve palsies bilaterally (i.e mydriasis, facial drooping, bulbar symptoms)
3. back or limb pain
4. autonomic dysfunction (urinary retention/ constipation)
5. cardiac involvement (arrythmias, BP fluctuations)
6. respiratory muscles involvement can lead to failure (20% die from this)

Question 4

diagnosis?

Answer 4

diagnose based on clinical picture, CSF analysis, nerve conduction studies

1. CSF will show high protein but normal WBC (due to abnormal CSF protein absorption by arachnoid vili)
2. nerve conduction studied show prolonged evoked potentials

Question 5

management?

Answer 5

IV IG or plasmapheresis

-steroids offer NO BENEFIT

-monitor for disease progression and complications

Question 6

prognosis and DDx?

Answer 6

80% will recover within 6 months.

transverse myelitis: etiology is idiopathic or infectious (EBV, CMV) or MS. UMNL: paraplegia sensory loss with urinary incontinence NO CRANIAL nerve involvement. CSF analysis is normal or high lymphocytes or IgG