Guillain-Barre syndrome

Question 1

What is Guillain-Barre syndrome?

Answer 1

An acute ascending inflammatory demyelinating polyneuropathy.

Affects the peripheral nervous system.

It causes acute, symmetrical, ascending weakness and can also cause sensory symptoms.

Question 2

Causes of Guillain-Barre syndrome?

Answer 2

Campylobacter jejuni
Cytomegalovirus (CMV) Epstein-Barr virus (EBV)
HIV
Vaccinations (tetanus, rabies, swine flu)

Question 3

Symptoms and signs for Guillain-Barre syndrome?

Answer 3

Progressive, symmetrical weakness of all the limbs.

Weakness is classically ascending i.e. the legs are affected first

Reflexes are reduced or absent

Paraesthesia

Cranial nerve involvement
- diplopia
- bilateral facial nerve palsy
- oropharyngeal weakness

Hx of gastroenteritis

Autonomic dysfunction
- Urinary retention
- Diarrhoea
- Arrhythmias

Lower back pain due to radiculopathy

Question 4

IVx for Guillain-Barre syndrome?

Answer 4

Lumbar puncture (raised protein, normal WCC)

Nerve conduction studies
- decreased motor nerve conduction velocity due to demyelination
- prolonged distal motor latency
- increased F wave latency

Question 5

Management of Guillain-Barre syndrome?

Answer 5

Analgesia -NSAIDs or Opiates

VTE prophylaxis: TEDS + LMWH

1st line: IV immunoglobulins (IVIG)
or Plasmapheresis is an alternative.