Guillain-Barre syndrome

Question 1

What is the epidemiology and aetiology of Guillain-Barré syndrome (GBS)?

Answer 1

In 40% of cases, no cause is found

Possible triggers: 
Campylobacter jejuni 
CMV
Mycoplasma 
Herpes zoster 
HIV 
EBV
Vaccinations

Question 2

What is the pathophysiology of GBS?

Answer 2

Acute inflammatory demyelinating polyneuropathy (AIDP)

The trigger causes antibodies which attack nerves

It may advance quickly, affecting all limbs at once and can lead to complete paralysis

The progressive phase lasts 4wks followed by recovery

Proximal muscles are more affected:
Trunk
Respiratory
Cranial nerves esp VIII

Paralysis can be reversible

Question 3

How does GBS present?

Answer 3

Pain – back, limb

Autonomic dysfunction – sweating, raised pulse and BP, arrhythmias

Respiratory involvement

Numbness – starting distally and progressing centrally

Progressive ascending weakness

Bifacial weakness and other cranial neuropathies

Flaccid tetra/paraparesis

Areflexia

Question 4

How do you investigate GBS?

Answer 4

Nerve conduction studies:
Slow conduction

CSF:
Raised protein - thought to reflect the widespread inflammation of the nerve roots +
Normal WCC
(= albuminocytologic dissociation)

FVC:
Lower in respiratory involvement -
requires ventilation sooner rather than later

Question 5

How do you manage GBS?

Answer 5

Always admit

Inform ITU early

Monitor: 
Forced vital capacity - if lower than 1L – admit to ITU 
BP 
ECG 
Swallow – low threshold for NG feeding 

Manage:
DVT prophylaxis 
IVIg 
2g/kg total dose/5 days OR 
Plasma exchange =
Equally effective though less available and more cumbersome 
Alternate days for 7/9 administrations

Question 6

What is the prognosis for GBS?

Answer 6

Recovery may occur without any specific treatment

Though failure to recognise may cause death:
Severe weakness, aspiration, respiratory failure
Autonomic instability
Major cause
Sudden severe hypotension
Cardiac arrythmia