Guillain-barre syndrome

Question 1

Define Guillan-Barre syndrome

Answer 1

Acute inflammatory neuropathy–

defined as syndrome causing motor difficulties, absence of deep tendon reflexes, parasthesia, and high albumin in the CSF

The demyelinating polyradiculopathy is most common variant

Question 2

Aetiology and risk factors of Guillan-Barre syndrome

Answer 2

Immune mediates attack of the myelin sheath or schwann cells

Most GBS patients have a hx of infections in 6 weeks prior, often respiratory or gastroenteritis.

Main causing organisms are VIRAL (Cytomegalovirus, Epstein barr virus, Hep E) and some bacterial (Campylobacter and mycoplasma)

jejuni infection precedes about 60% to 70% of AMAN and acute motor-sensory axonal neuropathy

Question 3

Signs and Sx of Guillan-Barre syndrome

Answer 3

Progressive symmetrical muscle weakness that affects the lower limbs before the upper limbs,
DISTAL > Proximal
LMN signs
Arriflexia, flaccid paralysis

+ paresthesia in affected areas -usually fist Sx

affects Cranial nerves, most common 7, 9, 10, 3/4
Speech impediments, facial weakness, eye issues
Shortness of breath-respiratory muscle paralysis (over weeks)-30% of patients

CAn get ANS signs:
Hypotension, tachycardia, postural hypotension
Urinary retention

Other variants exist but rarely worth mentionning–miller fischer syndrome- pure Cranial nerve

Question 4

Investigations of Guillan-Barre syndrome

Answer 4

Nerve conduction studies-slowing down on lower nerves

CSF-Mainly high protein

LFT can be raised after symptoms

Question 5

Management of GBS

Answer 5

admit if advanced /safety
Immediate IVIG for pt + support–usually for 5 days

can use plasma exchange- as good as IVIG. Preffered if RENAL FAILURE

pt will recover very fast after starting IVIG- a few days improve sx a lot

but full recovery can take a year

Question 6

Long term prog and complicaitons of GBS

Answer 6

Can be bad in the moment but most recover very well
most can walk on their own within 6 months
espect full recover in 1 year