Guillan Barre

Question 1

What is Guillan Barre Syndrome

Answer 1

Idiopathic polyneuropathy likely occurring s/p infection

Question 2

What are some viral triggers of GBS

Answer 2

GI/Respiratory infx
Cambylobacter
CMV
EBV
HIV
Zika 
(can also occur s/p flu vaccine, surgery, or trauma

Question 3

What is the pathophys of GBS

Answer 3

• Infection causes immune response (Ab production)
• Virus has molecular mimicry, so Abs attach to peripheral nerves instead
• Macrophages destroy peripheral nerves causing acute polyneuropathy (Abs can attack axons or myelin)

Question 4

What are the types of GBS

Answer 4

AIDP: acute inflammatory demyelinating polyneuropathy (MC)
AMAN: acute motor axon neuropathy
AMSAN: acute motor and sensory axon neuropathy
Miller Fisher Syndrome

Question 5

What happens during AIDP

Answer 5

Progressive symmetric weakness with depressed DTR causes paresthesias in hands and feet

Question 6

What happens during AMAN

Answer 6

DTR can be preserved, there is no sensory involvement

Question 7

What happens during AMSAN

Answer 7

AMAN+ sensory nerve involvement

More severe than AMAN

Question 8

What happens during Miller Fisher Syndrome

Answer 8

Affects ocular nerves only- Ophthalmoplegia w/ ataxia/areflexia
(Uncommon to have extremity weakness)

Question 9

Explain CSF involvement with GBS

Answer 9

Macrophages destroy the peripheral nerve and dural attachment= CSF layer is broken
Proteins escape thru broken layer INTO the CSF

Question 10

What are signs and symptoms of GBS

Answer 10

-Symmetric ascending muscle weakness and diminished DTR- Start in LE–>Trunk–>UE
-Neuropathic pain (radicular)
-Sensory (mild paresthesias)
-Gait disturbance (ataxia out of proportion to muscle weakness)
+/- CN involvement

Question 11

What is peak onset of symptoms

Answer 11

W/in 4 weeks, most by 3 wks.

Question 12

Who should you consider GBS in

Answer 12

kids with acute gait disturbances

Question 13

What is a very concerning Sx of GBS

Answer 13

respiratory failure requiring mechanical vent

Question 14

How can you diagnose GBS

Answer 14

LP: Elevated protein with normal WBC (pro 55-200 mg)

BUT- will be normal in first 2-3 days- abnormalities appear by 1 week and peak by 3-6 weeks

Question 15

What electrodiagnostic studies can be done for GBS and why do we do them

Answer 15

Nerve conduction studies and EMG (not for Dx, but for classifying GBS and determining prognosis)

Question 16

How do you make a clinical diagnosis of GBS (Preferred)

Answer 16

rapidly evolving paralysis with Areflexia
absence of constitutional symptoms
characteristic antecedent events

Question 17

When should you consider al alternate Dx

Answer 17

Fever
CSF leukocytosis
Meningismus
Papilledema
Painless weakness
Persistent asymmetry Sx

Question 18

How do you treat GBS

Answer 18

• *Supportive care; +/- hospital, close monitor for resp. and CV function, DVT prophylaxis, Mechanical vent for resp. failure
• IVIG, Plasmapheresis

Question 19

What treatment do you NOT use

Answer 19

Corticosteroids! no benefit

Question 20

How long before recovery of GBS

Answer 20

Spontaneous recovery w/in 3-4 weeks of onset

Improvement follows inverse to direction of onset (LE–>trunk–>UE, recovery will be UE–>trunk–>LE)

Question 21

What is the last to recover

Answer 21

DTR

Question 22

What features indicate poor prognosis

Answer 22

CN involvement
Intubation
Max disability at time of presentation

Question 23

Who should be involved in recovery

Answer 23

PT
OT
Speech therapy