Guillain-Barré Syndrome Flashcards
What is Guillain-Barré Syndrome (GBS)?
Guillain-Barre syndrome (GBS) is an acute inflammatory neuropathy.
It is a clinically defined syndrome characterised by motor difficulty, absence of deep tendon reflexes, paraesthesias without objective sensory loss, and increased cerebrospinal fluid albumin with a normal cell count (albuminocytological dissociation).
What is the most common variant of GBS?
Acute inflammatory demyelinating polyradiculoneuropathy is the most commonly encountered variant.
What infections trigger GBS?
It is usually triggered by an infection and is particularly associated with to campylobacter jejuni, cytomegalovirus and Epstein-Barr virus.
What is the average time between infection and GBS?
Typically 6 weeks.
Briefly describe the pathophysiology of GBS
Guillain-Barré is thought to occur due to a process called molecular mimicry. The B cells of the immune system create antibodies against the antigens on the pathogen that causes the preceding infection. These antibodies also match proteins on the nerve cells. They may target proteins on the myelin sheath of the motor nerve cell or the nerve axon.
What are the risk factors for GBS?
- Preceding viral illness
- Preceding bacteral illness
- Hepatitis E infection
- Immunisation
- Cancer and lymphoma
- Older age
- HIV infection
- COVID-19 infection
- Male
What are the clinical features of GBS?
- Muscle weakness
- Paraesthesia
- Back and leg pain
- Respiratory disness
- Speech problems
- Areflexia/ hyporeflexia
- Facial weakness
- Bulbar dysfunction causing oropharyngeal weakness
- Extra-ocular muscle weakness
- Facial dropp
- Diplopia
- Dysarthria
- Dysphagia
Briefly describe the clinical course of GBS
Symptoms usually start within 4 weeks of the preceding infection. The symptoms typically start in the feet and progresses upward. Symptoms peak within 2-4 weeks, then there is a recovery period that can last months to years.
What investigations should be ordered for GBS?
- Nerve conduction studies
- Lumbar puncture
- LFTs
- Spirometry
How is GBS diagnosed?
A diagnosis of Guillain-Barré syndrome is made clinically. The Brighton criteria can be used for diagnosis.
What do nerve conduction studies show with GBS?
Reduced nerve conduction.
What does a lumbar puncture shown in GBS?
Elevated CSF protein, normal/slightly high lymphocytes with a normal cell count and glucose
Briefly describe the treatment of GBS
- IV immunoglobulins
- Plasma exchange (alternative to IV IG)
- Supportive care
- VTE prophylaxis
Why is VTE prophylaxis needed in patients with GBS?
Pulmonary embolism is a leading cause of death.
What percentage of patients with GBS require ventilatory rupport?
Respiratory failure is common in GBS, and approximately 20% to 30% of patients need ventilatory support in an intensive care unit (ICU)
