Guillain-Barre Syndrome (Exam 4) Flashcards
Guillain Barre Syndrome
Acute, immune-mediated polyneuritis - progressive, (ascending) symmetric muscle weakness accompanied with absent or decreased deep tendon reflexes
With GBS patient usually present
Few days to a week after onset of symptoms
GBS: Weakness
Ascending
Varying from difficulting walking to complete paralysis
GBS: Clinical Manifestations
Paraesthesia in hands and feet 80%
Pain in back and extremities 66%
Dysautonomia 70%
GBS: Dysautonomia
-Tachycardia (most common)
-Labile blood pressure
-Orthostatic hypotension
-Ileus
-Urinary retention
GBS is often preceded by
Viral infection
Immunization
Trauma
Surgery
GBS: Progression
Progress over a period of 2 weeks and by 4 weeks 90% of patients have reached nadir (peak)
90% of patient with GB reach nadir by
4 weeks
GBS: Diagnosis
History and Physical
Cerebrospinal Fluid
Nerve Conduction Study / Needle EMG
GBS Diagnostic: CSF
Only after one week of onset
Protein increased
Normal WBC
GBS Diagnostic: Nerve Conduction and Electromyography
Valuable for not only confirming diagnosis, but also regarding prognosis
GBS: Astute routine physical assessment
-Monitor for progression of the disease
-15-30% require mechanical ventilation (this can happen very quickly)
-Deterioration can occur rapidly
-Assess for gag and corneal reflexes
-Frequent VS d/t autonomic changes = ICU
GBS: Treatment
Plasmapheresis
IV immune globulin
(both have = efficacy)
ADMINISTERED WITHIN 4 WEEKS OF ONSET
GBS: IVIG Treatment
Immune globulin given over period of 5 days
GBS: Plasmaheresis
-Removes circulating antibodies, complement, and soluble biological response modifiers
-4-6 treatments over 8-10 days
GBS: Prognosis
95% survive
75% completely recover
25% have residual weakness after 3 years
3% suffer relapse of muscle weakness and tingling many years post initial attack
