GBS/CIDP

Question 1

GBS symptoms/clinical features?

Answer 1

CN (except I, II, VIII) + Motor + Sensory + Autonomic

1. CN palsies, especially bulbar
2. Ascending motor weakness
3. Paraesthesia or sensory loss
4. Autonomic: postural hypotension, bladder/bowel, labile BP

Question 2

What are the precipitating factors for GBS? (4)

Answer 2

1. Respiratory or GI infection
2. Surgery
3. Vaccination
4. Intercurrent malignancies (e.g. Lymphoma)

Question 3

GBS - PRICMCP?

Answer 3

P: ascending motor, sensory, CN symptoms. Autonomic features - bowel/bladder, postural, arrythmia. If this happened more than once suspect CIDP

R: GI/Resp infection, surgery, vaccination, concurrent malignancy

I: LP, NCS/EMG, lung-function, MRI

C: respiratory failure, Falls, ICU admission

M: NIV/intubation, IVIG, PEX (not steroids), PT

C: how are you coping, discharge plan?

Question 4

Examination findings to report for GBS/CIDP? (4)

Answer 4

1. CN - especially Bulbar + ophthalmoplegia (MFS - ataxia, areflexia, ophthalmoplegia)
2. Distal motor weakness - 25% will have more proximal weakness
3. Sensory - mainly posterior columns (vibration/proprioception)
4. Autonomic - postural BP, look for cardiac arrhythmia (ask for it)

Question 5

What investigations would you ask for & what do you look for in this patient with suspected GBS?

Answer 5

T:

• CSF results (albumin-cytological dissociation: high protein, lack of WCC)
• evidence of recent infection (Monospot, cold-agglutinins, CMV, HIV, Campylobactor)
• NCS/EMG (slowed motor conduction, conduction blocks, increased distal motor latencies, reduced sensory AP)

E: exclude spinal cord pathology (MRI), other variants of GBS (MFS - Anti-GQ1B)

Severity/complications: Lung-function test (spirometry) look for reduced FEV1, FVC suggestive of respiratory muscle involvement.

Question 6

What are DDx of GBS? (5)

Answer 6

Other causes for acute ascending motor paralysis include (3 P’s)

1. Polio

2. Diphtheria

3. Botulism

4. Porphyria
5. PAN

Question 7

Prognosis of GBS? What is a feature of poor prognosis?

Answer 7

Good - most will make a complete recovery.

2% mortality (due to respiratory complications, PE, arrhythmias)

10% may have major residual deficit, especially if the symptoms do not resolve in 3 weeks.

Question 8

What is your approach to managing GBS? (4)

Answer 8

1. Physiotherapy to prevent contractures, walking aids, splints, foot orthoses, fall prevention measures, educate.
2. Respiratory support in ICU if VC <1L
3. Plasmapheresis or IVIG - shortens time to recovery
4. Steroids (generally not helpful)/ImmSx
5. DVT prophylaxis