Guillain-Barre Syndrome

Question 1

What type of neurological condition is GBS?

What infections trigger it?

Answer 1

It is an immune-mediated demyelination of the peripheral nervous system often triggered by an infection (usually campylobacter jejuni, cytomegalovirus and Epstein-Barr virus)

Question 2

What are the features of GBS?

Answer 2

Initial presentation:
Back/leg pain or parasthesia

Progressive, symmetrical weakness of all limbs
Weakness is classically ascending feet initially then moving up body
Mild sensory symptoms - distal parasthesia
Reduced or absent reflexes

Other features:
Hx of gastroenteritis
Respiratory muscle weakness
CN involvement - diplopia, bilateral facial nerve palsy, oropharyngeal weakness
Autonomic involvement - urinary retention, diarrhoea
Fluctuating BP
Arrhythmias

Question 3

What investigations are carried out to diagnose GBS?

Answer 3

Brighton criteria

Nerve conduction study:
Reduced signal through the nerves

Lumbar puncture:
Raised Protein + normal WBC + normal glucose = albuminocytologic dissociation

Antibodies:
Anti-GM1 in 25%

Question 4

What is the management for GBS?

Answer 4

IV immunoglobulin - 0.4g/Kg/day for 5 days

Plasma exchange - 200-250ml/Kg over 7-14 days, 4 exchanges (2x plasma volume)

IPPV (intermittent positive pressure ventilation) if FVC <15ml/Kg

Thromboprophylaxis - TED stockings and s/c LMWH as
(PE is leading cause of death in GBS)

Respiratory obs:
Check FVC
If ABGs/RR/SaO2 abnormal, then often patient will be peri-arrest

Question 5

What is Miller Fisher syndrome?

What are its features?

Answer 5

A variant of GBS

Features:
Triad of ophthalmoplegia, areflexia and ataxia
Descending paralysis rather than typical ascending seen in other forms of GBS
Anti-GQ1b antibodies are present in 90%