Guillain-Barre syndrome

Question 1

Define Guillain Barre Syndrome

Answer 1

Acute inflammatory demyelinating polyneuropathy

Characterised by motor difficulty, absence of deep tendon reflexes, paraesthesia, increased CSF albumin

Question 2

Aetiology of Guillain Barre Syndrome

Answer 2

Immune-mediated attack on the myelin sheath or Schwann cells of sensory and motor nerves
Frequently triggered by an antecedent infection (Campylobacter jejuni, HIV, herpes), malignancy, post vaccination

Question 3

Presenting symptoms of Guillain Barre Syndrome

Answer 3

Progressive symptoms of <1 months duration of ascending symmetrical limb weakness and parasthesiae

Resp distress (dyspnoea on exertion)
Speech problems (dysarthria)
Paraesthesia
Back/leg pain 
Diplopia
Dysphagia

Question 4

What is the Miller Fisher variant

Answer 4

Ophthalmoplegia, ataxia and arreflexia

Question 5

Signs of Guillain Barre Syndrome

Answer 5

Arreflexia/hyporeflexia/flaccid paralysis
Impaired sensation
Facial weakness and droop
Dysautonomia - sinus tachy, HTN, postural hypo, urinary retention, ileus
TIIRF - CO2 flap, bounding pulse, drowsiness
Extra-ocular eye weakness
Anisocoria and non-reactive pupil
Ptosis
Ataxia

Question 6

Investigations for Guillain Barre Syndrome

Answer 6

LP: raised CSF protein/albumin, cell count + glucose normal
Nerve conduction: reduced conduction velocity or a block (may be normal early)
Bloods: positive anti-ganglioside Abs (Miller Fisher)
Spirometry: reduced fixed viral capacity
ECG: arrhythmia