Guillain Barre

Question 1

What other names is Guillain Barre known by?

Answer 1

AIDP - Acute Inflammatory Demyelinating Polyradiculopathy

Postinfective polyneuropathy

Question 2

When does it usually present?

Answer 2

Normally follows 1-3 weeks after a respiratory infection or diarrhoea. Often mild infections. Campylobacter jejuni particularly implicated as a cause of the diarrhoea and bodes a more serious disease.

Question 3

What is the classic presentation?

Answer 3

• Distal parasthesia
• Little sensory loss
• Proximal weakness, distal to proximal weakness, global weakness
• Symptoms ascend up the limbs and body over a period of days to weeks (glove and stocking)
• 50% asymmetrical facial weakness
• other complications - risk of intercostal and diaphragmatic weakness leading to respiratory failure.
• 60% autonomic dysfunction - arrhythmias, urinary retention and constipation

Question 4

How is a diagnosis made?

Answer 4

Usually clinically

• nerve conduction studies
• LP (see section)
• Miller-Fisher syndrome will have anti-GQ1b ganglioside antibodies

Question 5

What is the differential diagnosis? What are suggestive of a differential diagnosis?

Answer 5

• Poliomyelitis
• myasthenia gravis
• botulism
• primary muscle diseases

Alternative diagnosis if:

• Significant asymmetry - vasculitis
• Marked CSF lymphocytes - HIV, Lyme disease, Polio
• Sensory level - spinal cord syndrome
• Marked bladder or bowel dysfunction - spinal cord syndrome

Question 6

How is GB usually treated?

Answer 6

• Continual cardiac monitoring, vital capacity and O2 sats measurement
• IV immunoglobulin
• Supportive measures may be needed
  NB. steroids and immunosuppressive agents have not been found to work in acute GB

Question 7

What is the usual course of the disease?

Answer 7

80% recover, though it may be over many months.
10-15% require longs stays on ITU, years.
Most deaths are due to supportive failure.
After 8 months becomes ‘chronic’