Guillain-Barre Syndrome Flashcards
What is Guillain-barre syndrome
Acute inflammatory demyelinating polyneuropathy. Autoimmune disorder attacking peripheral nerves in different ways depending on the type (can by the myelin sheath or the axon itself).
Describe the 4 type of guillain-barre syndrome
- AIDP – acute inflammatory demyelinating polyradiculoneuropathy, this is the most common accounting for 95%
- AMAN – acute motor axonal neuropathy
- AMSAN – acute motor and sensory axonal neuropathy
- Acute pandysautonomia
What infections commonly cause guillain-barre syndrome
Thought to be improper immune response to an infection. Most commonly this is following Campylobacter Jejuni other include • CMV • Mycoplasma • Herpes zoster • HIV • EBV • Vaccination
Describe the signs and symptoms of guillain-barre syndrome
Back and limb pain
Ascending symmetrical muscle weakness and hyporeflexia or areflexia
Previous history of an infection
Paraesthesia
Autonomic dysfunction can occur causing tachycardia and arrhythmias, postural hypotension, hypertension, urinary incontinence and ileus
Describe the classical presentation of guillain-barre syndrome
Usually begins with tingling toes and fingers and spreads to hands, feet, legs and arms.
This then develops into weakness and numbness
Resulting in difficulty walking, moving eyes, face and incontinence
Can progress very rapidly leading to complete paralysis
Proximal muscles affected more than in other conditions e.g. trunk, respiratory and cranial
Peak of symptoms at 4 weeks with a brief plateau and then recovery over weeks to months
How is suspected guillain-barre syndrome investigated?
Nerve conduction studies – slow conduction
Lumbar puncture showing high protein levels in the CSF and low levels of White cells
Monitor FBC, blood gasses and spirometry closely
How is Guillain-barre syndrome managed?
No cure but can attempt to alleviate the symptoms and must be monitored
Can do a plasma exchange or give intravenous immunoglobulins
May need mechanical ventilation
Nutritional support, DVT prophylaxis, catheter, laxatives and bowel care and pain control
As it is inflammatory it is self-limiting and nerves can recover after the immune attack
Steroids have NO use here
What complications can occur as a result of guillain-barre syndrome
Paralysis Death if the diaphragm becomes paralysed DVT/PE due to immobility SIADH Renal failure secondary to IV Ig Hypercalcaemia due to immobility
What is miller fisher syndrome?
Variant of Guillain-Barre syndrome associated with ophthalmoplegia, areflexia and ataxia with the eye muscles are typically affected first. Usually presents as a descending paralysis rather than ascending as seen in other forms of Guillain-Barre syndrome. Anti-GQ1b antibodies are present in 90% of cases.
