Guillain-Barre Syndrome

Question 1

GBS is the most common cause of what?

Answer 1

acute neuromuscular paralysis

Question 2

what are the 4 characteristics of GBS?

Answer 2

symmetric
ascending
autoimmune inflammation
peripheral nerves

Question 3

what does a patient with GBS usually have a history of?

Answer 3

upper respiratory or GI infection 2-4 weeks ago

Question 4

what infection is most commonly associated with GBS?

Answer 4

campylobacters jejuni enteritis

Question 5

what is the pathogenesis of GBS?

Answer 5

infection/trauma causes immune response that is directed at myelin of peripheral nerves (demyelination occurs)

Question 6

what do the antibodies attack to cause demyelination of peripheral nerves?

Answer 6

node of Ranvier
OR
Schwann cell

Question 7

what is often the first noticeable symptom of GBS?

Answer 7

gait disturbance

Question 8

what 5 autonomic dysfunctions can occur that can be life threatening?

Answer 8

cardiac irregularities
hypo/hypertension
facial flushing
sweating abnormalities
pulmonary dysfunction

Question 9

what are 2 things notable on physical exam?

Answer 9

diminished/absent reflexes
symmetric weakness

Question 10

what is the symptomatic nadir for most patients with GBS?

Answer 10

up to 4 weeks of symptom onset

Question 11

what are 2 mandatory diagnostics?

Answer 11

lumbar puncture
neurophysiology studies

Question 12

what will the CSF look like to diagnose a patient with GBS?

Answer 12

elevated protein with normal WBC count (albuminocytological dissociation)

Question 13

how long can CSF take to present + for GBS?

Answer 13

2-3 weeks

Question 14

which diagnostic is the most specific and sensitive for diagnosing GBS?

Answer 14

electromyography (EMG)

Question 15

what is the general treatment for GBS? (3)

Answer 15

vigilant supportive care:

pain control
DVT prophylaxis
low dose heparin

Question 16

what 2 medications can be used to treat neuropathic pain associated with GBS?

Answer 16

gabapentin
carbamazepine

Question 17

what are 2 treatment options available to patients and what are their jobs?

Answer 17

plasmapheresis - removes circulating antibodies

IVIG - neutralizes antibodies/inflammation

Question 18

what is NOT recommending in patients with GBS?

Answer 18

glucocorticoids

Question 19

in which patients is treatment with plasmapheresis or IVIG recommended? (2)

Answer 19

nonambulatory adult patient within 4 weeks of symptom onset

ambulatory adult patient not recovering within 4 weeks of symptom onset

Question 20

what is the prognosis of GBS?

Answer 20

function returns slowly over weeks-months

Question 21

what is the treatment for relapses with increased weakness?

Answer 21

plasmapheresis or IVIG