Guillian Barre Flashcards
what is GB also known as
acute inflammatory demyelinating polyneuropathy
pathology of GBS
autoimmune disorder that destroys myelin sheath surrounding peripheral nerves
what typically precedes GBS
2/3 cases have an infection 2 weeks prior to GBS onset
what infections typically precede GBS
upper respiratory or GI
what percentage of cases have idiopathic origins
27
what are the 4 distinct phases of GBS
latency
progression
plateau
recovery
latency phase definition
between onset of preceding illness and neuropathic symptoms
progression phase definition
onset of symptoms until nadir
- point in which symptoms are most severe
plateau phase definition
period of weakness
clinical motor manifestations of GBS
symmetrical ascending loss of motor function
reduced deep tendon reflexes
can involve respiratory / oral muscles
in _____% of cases, mechanical ventilation may be indicated due to _____
20-30%
paresiss/paralysis of diaphragm and intercostal musculature
sensory clinical manifestations of GBS
distal hyperesthesias, paresthesias, numbness
decreased proprioception
stocking-glove
cramping pain
explain stocking and glove pattern
not a dermatomal pattern, more global
– ie entire foot and hand
autonomic clinical manifestation of GBS
low cardiac output
arrythmias
BP fluctuations
peripheral pooling of fluid
urinary retention
which gender is GBS seen more in
males
what percentage of patients reach symptom nadir in 1-3 weeks from onset
50
explain recovery rate of GBS
gradual recovery of strength 2-4 wks after plateau
about 80% are ambulatory within 6 months of symptom onset
explain % of cardiac event death in those with GBS
3-5%
what are the most common residual deficits seen in GBS
foot drop
facial weakness
hand atrophy
sensory ataxia
dyesthesia
what is dyesthesia
abnormal sensation that is unpleasant and can be pain-like
how is the diagnosis of GBS completed
clinical presentations
CSF sampling
EMG
nerve conduction velocity testing
when one is diagnosed with GBS, what immediately occurs? why?
hospitilization due to risk of respiratory compromise
what are the options for medical management of GBS
Plasmapheresis
IV immunoglobulin
what is plasmapheresis
removal of plasma from blood to remove antibodies from blood stream
what is IV immunoglobulin treatment
injection of proteins that interrupt myelin destruction
during evaluation, what major system should be focused on? when should this be checked?
cardiopulm system review
before, during and after exercise
motor exam during GBS eval should include
oculomotor
facial muscles
cranial nerve
grip strength
what areas are at risk of pressure breakdown in those with GBS
feet - bottom specifically
hands
what phases of GBS are considered to be “acute”
latency and progression
what “hat” do we wear during acute phase
preventative
what interventions applicable during acute GBS
respiratory
pain control
positioning / splinting
monitor decline of muscle function
PROM/AAROM in pain-free ranges
what setting is the acute phase of GBS treated in
acute care
contraindications during acute phase GBS
strengthening (not even AROM)
fatiguing patient
during all phases of GBS, what should be focused on
monitoring of prolonged postexercise weakness and DOMS
what interventions are indicated during plateau phase GBS
all the same from acute, may begin to incorporate AROM
upright positioning
bed mobility
light functional skills
what is contraindicated during plateau phase GBS
strengthening
fatiguing patient
what interventions are indicated during recovery phase GBS
low rep, sub max non-resisted ex
multi joint functional activities
aerobic training with monitoring
