Guillaine Barre Syndrome

Question 1

Define Guillain-Barre syndrome

Answer 1

Acute inflammatory polyneuropathy

2 forms
demyelinating
axonal

Question 2

Explain the aetiology/risk factors of Guillain-Barre syndrome

Answer 2

An inflammatory process where antibodies after a recent infection react with self-antigen on myelin or neurons

There is often no aetiological trigger identified (40% of cases are idiopathic)

2/3rds present weeks following Gastroenteritis or Flu like illness

Other causes: 
Post-infection (1-3 weeks) - bacterial (campylobacter jejuni), Zika!
 HIV, herpes viruses 
Malignancy - e.g. lymphoma 
Post-vaccination

Question 3

Recognise the presenting symptoms of Guillain-Barre syndrome

Answer 3

PROGRESSIVE symptoms
< 1 month duration of:

ASCENDING symmetrical limb weakness (lower > upper)

ASCENDING paraesthesia

Cranial nerve involvement (leading to, for example, dysphagia, dysarthria, facial weakness)

Respiratory muscles may be affected in SEVERE cases

Miller-Fisher Variant (RARE) = ophthalmoplegia, ataxia, arreflexia

Question 4

Recognise the signs of Guillain-Barre syndrome on physical examination

Answer 4

1.General MOTOR Examination ;
Hypotonia  
Flaccid paralysis  
Symmetrical weakness
Arreflexia - absent (ascending upwards from feet to head) 

2. General SENSORY Examination
   Impairment of sensation in multiple modalities (ascending from feet to head)
3. Cranial Nerve Palsies
   Facial nerve weakness

Abnormality of external ocular movements
If pupil constriction is affected, consider botulism

4. Type II Respiratory Failure
   Due to paralysis of respiratory muscles
5. Autonomic Function
   Assess postural blood pressure change and arrhythmias

Question 5

Identify appropriate investigations for Guillain-Barre syndrome

Answer 5

1. Lumbar Puncture
   HIGH protein
   NORMAL cell count and glucose
2. Nerve Conduction Study
   Reduced conduction velocity
   NOTE: it may be normal in the early stages of the disease
3. Bloods
   Anti-ganglioside antibodies in Miller-Fisher variant + 25% of Guillain-Barre cases
4. Spirometry
   Reduced fixed vital capacity - suggests ventilatory weakness
5. ECG
   Arrhythmias may develop

Question 6

How do we mx GBS?

Answer 6

IVIG (human)
or
Plasma Exchange

If renal failure or IgA deficiency;
Plasma Exchange