Guillain Barre Syndrome Flashcards
What is Guillain Barre?
Rapid onset muscle weakness
Autoimmune damage to peripheral nervous system
What are initial symptoms?
Changes in sensation or pain with muscle weakness begining in hands and feet
Spreads to the arums and upper body
Bilateral
How long do symptoms take to develop?
Hours to weeks
What is the danger?
Develop weakness of breathing muscles resulting in breathlessness and type 2 repsiratory failure:
Elevated CO2, Low O2
This requires mechanical ventilation
Change in autonomic NS function –> herat rate and blood pressure affected
What features on examination?
Reduced power
Hyporeflexia
4 main features of GBS?
Numbness, tingling and pain
Rapid onset Weakness - face, swallowing, eye, legs
Respiratory failure
Autonomic dysfucntion: palpitations, BP fluctuations
What can trigger CBS?
Infection:
Campylobacter jejuni infection
Cytomegalovirus infection
Influenza
What antibodies in GBS?
Anti-ganglioside antibodies
Ganglioside is a substance in peripheral nerves
Diagnosis of GBS?
Rapid development of muscle paralysis, absent reflexes, absence of fever, likely cause - CAmpylobacter infection
What Ix in GBS?
LP - CSF analysis Nerve conduction studies Antiganglioside antibodies U&E - hypokalaemia? hypocalcaemia? hyponatraaemia? MRI - spinal cord compression?
Spirometry if there is neuromuscular respiratory compromise
What does CSF show in GBS?
Elevated protein >0.55g/L
<10/mm3 WCC
Mx for GBS?
Immunotherapy:
Plasmapheresis - remove antibodies from circulation
IV immunoglobulins - bind antibodies and neutralise - start within 2 weeks of onset, takes time to work
Respiratory failure:
May require intubation and mechanical ventilation
Rehabilitation Physiotherapy - Occupational therapy SALT Social worker Psychologist Nurses
Describe rehabilitation in GBS
Physiotherapy - strength, endurance, gait training, increases in mobility, maintenance of posture, joint function
Occupational therapy - improve everyday function with domestic and community tasks including driving and work. Home modifications, gait aids, orthotics and splints may be provided
SALT - speech and swallowing problems. Support communication in those who require ongoing breathing support
Dieticians - nutritional support
Social worker
Psychologist -c counselling and support, interventions for anxiety, fear, depression
Nurses
What complications for GBS? Prognosis?
Severe infection Blood clots Cardiac arrest due to autonomic neuropathy Skin breakdown Pressure sores
Approximately 90% of patients with GBS make a virtually complete recovery at 6 months-1 year
Poor prognostic factors include elderly age, other advanced medical co-morbidities, axonal changes on neurophysiology, initial disease severity requiring prolonged ventilation.
