Guillain-Barre syndrome Flashcards
What is Guillain-Barre syndrome?
An acute paralytic polyneuropathy that affects the peripheral nervous system.
It causes acute, symmetrical, ascending weakness and can also cause sensory symptoms.
What is Guillain-Barre syndrome usually triggered by?
Usually triggered by an infection and is particularly associated with Campylobacter jejuni, cytomegalovirus (CMV) and Epstein-Barr virus (EBV).
Pathophysiology of Guillain-Barre syndrome?
A process called molecular mimicry. The B cells of the immune system create antibodies against the antigens on the triggering pathogen.
These antibodies also match proteins on the peripheral neurones. They may target proteins on the myelin sheath or the nerve axon itself.
Typical presentation of Guillain-Barre syndrome?
Symptoms usually start within four weeks of the triggering infection.
They begin in the feet and progress upward. Symptoms peak within 2-4 weeks. Then, there is a recovery period that can last months to years.
2 main characteristic features of Guillain-Barre syndrome?
Symmetrical ascending weakness
Reduced reflexes
2 methods for diagnosis of Guillain-Barre syndrome?
Nerve conduction studies (showing reduced signal through the nerves)
Lumbar puncture for cerebrospinal fluid (showing raised protein with a normal cell count and glucose)
Management of Guillain-Barre syndrome?
Supportive care
VTE prophylaxis (pulmonary embolism is a leading cause of death)
IV immunoglobulins (IVIG) first-line
Plasmapheresis is an alternative to IVIG
What is GBS?
Ascending inflammatory demyelinating polyneuropathy characterised by an acute onset of bilateral and roughly symmetric limb weakness
Typical aetiology of GBS?
Typically occurs 1-3 weeks following an infection with common causes being campylobacter, mycoplasma and EBV
Clinical features of GBS?
Progressive ascending symmetrical limb weakness (usually starting with lower limbs)
Potential respiratory muscle involvement in severe cases
Potential cranial nerve involvement leading to diplopia, facial droop
Investigations for GBS?
Monitoring of forced vital capacity for respiratory muscle involvement
Serological tests:anti-ganglioside antibodies
Lumbar puncture: combination of elevated protein levels and normal white blood cell count
Management of GBS?
Mostly supportive management:
VTE prophylaxis: LMWH
Analgesias: NSAIDs or opiates for rediculopathy related back pain
Regular monitoring of FVC
Specific medical management includes:
IV immunoglobulin over 5 day course
Plasmapheresis
