Guillain-Barré Syndrome

Question 1

What is Guillain-Barré Syndrome?

Answer 1

idiopathic acute/subacute inflammatory demyelinating polyneuropathy

Question 2

MC microorganism a/w Guillain-Barré Syndrome?

Answer 2

Campylobacter jejuni

others:
EBV, cytomegalovirus, HIV, Zika

Question 3

Guillain-Barré Syndrome is the MC cause of ____ ?

Answer 3

acute atraumatic generalized paralysis in all age groups

Question 4

Explain the pathophys of Guillain-Barré Syndrome

Answer 4

• antecedent infection invokes immune response
• antibody production
• antibodies attach to peripheral nerve cells (molecular mimicry)
• macrophages attack peripheral nerves

-acute polyneuropathy
(select antibodies attack axons/myelin)

Question 5

What is the MC variant of GBS? what is it?

Answer 5

Acute inflammatory demyelinating polyneuropathy (AIDP)

• progressive symmetric weakness accompanied by absent or depressed DTRs
• Paresthesias in the hands and feet

Question 6

Characteristics of Acute Motor Axonal Neuropathy

Answer 6

• Japan and China
• DTRs may be preserved
• no sensory involvement

Question 7

Characteristics of Acute motor and sensory axonal neuropathy

Answer 7

• AMAN + sensory nerve involvement

- Higher severity than AMAN

Question 8

Characteristics of Miller Fisher syndrome

Answer 8

• Ophthalmoplegia w/ ataxia and areflexia

- only 25% develop extremity weakness

Question 9

What happens to the CSF in GBS?

Answer 9

• macrophages damage the peripheral nerve dural attachment
• breakdown of the peripheral nerve CSF
• allows passage of proteins into CSF

Question 10

What are sx of GBS?

Answer 10

• Progressive SYMMETRIC ascending muscle weakness weakness and diminished DTRs
• Neuropathic pain
• Sensory presentation
• Gait disturbance- ataxic component out of proportion to the muscle weakness
• cranial nerve may be involved
• respiratory failure

Question 11

What part of the body is initially affected in GBS?

Answer 11

Lower extremities
progressively involves the trunk
then upper extremities
-ultimately paralysis

Question 12

What is needed for dx of GBS?

Answer 12

LP

-elevated protein w/ nl WBC (albuminocytologic dissociation)

Question 13

When performing a LP for GBS, what do you need to consider?

Answer 13

• usually nl in 1st 2-3 days
• 90% will be abnormal at 1 week
• peak is 3-6 weeks

Question 14

What do you need to classify GBS?

You would defer this to electrophysiologist

Answer 14

Nerve conduction studies (NCS)
needle electromyography (EMG)

Question 15

How do you treat GBS?

Answer 15

Supportive Care:

• Hospitalization
• DVT prophylaxis
• close monitoring of respiratory and cardiovascular fxn

Immunotherapy
Plasmapheresis (to remove antibodies)

Question 16

Do you give corticosteroids in GBS?

Answer 16

NAHHHH not beneficial

Question 17

How long does recovery take from GBS?

Answer 17

spontaneous recovery 3-4 weeks from sx onset

Question 18

3 features that predict poor outcome in GBS?

Answer 18

• CN involvement
• intubation
• maximum disability at the time of initial presentation