Guillain-Barre Syndrome

Question 1

What is the definition of Guillan-Barre Syndrome?

Answer 1

An acute inflammatory demyelinating polyneuropathy

Question 2

What is the aetiology / risk factors involved with Guillan-Barre?

Answer 2

• Inflammatory process in which antibodies react with self-antigens on myelin or neurons after a recent infection
• There is often no aetiological trigger identified with 40% of cases being idiopathic
• Other causes include:
• > Post-infection (1-3 weeks) - bacterial, HIV, herpes viruses
• > Malignancy - e.g. lymphoma
• > Post-vaccination

Question 3

Summarise the epidemiology of Guillain-Barre.

Answer 3

UK incidence: 1-2/100,000

Affects all age groups

Question 4

What are the presenting symptoms of Guillain-Barre?

Answer 4

There are progressive symptoms which occurr in less than a month:

• ASCENDING symmetrical limb weakness (lower > upper)
• ASCENDING paraesthesia

Cranial nerve involvement (leading to, for example, dysphagia, dysarthria, facial weakness)

Respiratory muscles may be affected in SEVERE cases

Miller-Fisher Variant (RARE) = ophthalmoplegia, ataxia, arreflexia

Question 5

Signs of Guillain-Barre on examination - General motor exam

Answer 5

Hypotonia

Flaccid paralysis

Arreflexia (ascending upwards from feet to head)

Question 6

Signs of Guillain-Barre on examination - General sensory exam

Answer 6

Impairment of sensation in multiple modalities (ascending from feet to head)

Question 7

Signs of Guillain-Barre on examination - cranial nerve palsies

Answer 7

Facial nerve weakness

Abnormality of external ocular movements

If pupil constriction is affected, consider botulism

Question 8

How does Guillain-Barre cause type II resp failure?

Answer 8

Due to paralysis of respiratory muscles

Question 9

How to check if Guillain-Barre affects autonomic function?

Answer 9

Assess postural blood pressure change and arrhythmias

Question 10

What investigations should be conducted if Guillain-Barre is suspected?

Answer 10

• Lumbar puncture
• Nerve conduction study
• Bloods
• Spirometry
• ECG

Question 11

What would you find in an Lumbar puncture of a patient with Guillain-Barre?

Answer 11

HIGH protein

NORMAL cell count and glucose

Question 12

What would you find in a nerve conduction study of a patient with Guillain-Barre?

Answer 12

Reduced conduction velocity

NOTE: it may be normal in the early stages of the disease

Question 13

What would you find in the bloods of a patient with Guillain-Barre?

Answer 13

Anti-ganglioside antibodies in Miller-Fisher variant + 25% of Guillain-Barre cases

Question 14

What would you find in the spirometry of a patient with Guillain-Barre?

Answer 14

Reduced fixed vital capacity - suggests ventilatory weakness

Question 15

What would you find in an ECG of a patient with Guillain-Barre?

Answer 15

Arrhythmias may develop