Guillan Barre Flashcards
What is Guillan Barre Syndrome
Idiopathic polyneuropathy likely occurring s/p infection
What are some viral triggers of GBS
GI/Respiratory infx Cambylobacter CMV EBV HIV Zika (can also occur s/p flu vaccine, surgery, or trauma
What is the pathophys of GBS
- 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)
What are the types of GBS
AIDP: acute inflammatory demyelinating polyneuropathy (MC)
AMAN: acute motor axon neuropathy
AMSAN: acute motor and sensory axon neuropathy
Miller Fisher Syndrome
What happens during AIDP
Progressive symmetric weakness with depressed DTR causes paresthesias in hands and feet
What happens during AMAN
DTR can be preserved, there is no sensory involvement
What happens during AMSAN
AMAN+ sensory nerve involvement
More severe than AMAN
What happens during Miller Fisher Syndrome
Affects ocular nerves only- Ophthalmoplegia w/ ataxia/areflexia
(Uncommon to have extremity weakness)
Explain CSF involvement with GBS
Macrophages destroy the peripheral nerve and dural attachment= CSF layer is broken
Proteins escape thru broken layer INTO the CSF
What are signs and symptoms of GBS
-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
What is peak onset of symptoms
W/in 4 weeks, most by 3 wks.
Who should you consider GBS in
kids with acute gait disturbances
What is a very concerning Sx of GBS
respiratory failure requiring mechanical vent
How can you diagnose GBS
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
What electrodiagnostic studies can be done for GBS and why do we do them
Nerve conduction studies and EMG (not for Dx, but for classifying GBS and determining prognosis)
How do you make a clinical diagnosis of GBS (Preferred)
rapidly evolving paralysis with Areflexia
absence of constitutional symptoms
characteristic antecedent events
When should you consider al alternate Dx
Fever CSF leukocytosis Meningismus Papilledema Painless weakness Persistent asymmetry Sx
How do you treat GBS
- *Supportive care; +/- hospital, close monitor for resp. and CV function, DVT prophylaxis, Mechanical vent for resp. failure
- IVIG, Plasmapheresis
What treatment do you NOT use
Corticosteroids! no benefit
How long before recovery of GBS
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)
What is the last to recover
DTR
What features indicate poor prognosis
CN involvement
Intubation
Max disability at time of presentation
Who should be involved in recovery
PT
OT
Speech therapy
