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Neuro 2 > Guillian-Barre Syndrome > Flashcards

Guillian-Barre Syndrome Flashcards

1
Q

pathophysiology behind GBS

A
  • Immune system attacks Schwann cells in PNS (demyelinating)
  • Rapid progressive ascending motor weakness and diminished reflexes
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2
Q

What populations does this diagnosis demonstrate incidence trends towards?

A
  • Young adults and 5th-8th decade,
  • males > female

o Incidence increases with age, highest > 60 years
o Increases by 20% for every 10-year increase in age

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3
Q

etiology of GBS

A
  • Idiopathic
  • After viral or bacterial infection
  • Autoimmune disease
  • Allergic response
  • Other
    o HIV, herpes
    o Vaccinations
    o Surgery
    o Post-natal (after birth)
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4
Q

clinical presentation of GBS

A
  • Progression of symptoms from 12 hours – 28 days before plateau (nadir)
    o Nadir for 2-4 weeks
    o Recovery from proximal to distal
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5
Q

What are common signs and symptoms associated with this diagnosis?

A
  • SYMMETRICAL motor weakness - distal to proximal
  • hyporeflexia or areflexia
  • CN involvement
  • INCREASED pain
  • autonomic dysfunction
  • respiratory difficulties
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6
Q

Which CN is most frequently involved? What motion does this CN contribute to?

A

CN VII
- smiling
- frowning
- whistling
- drinking through a straw

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7
Q

CN involved in double vision

A

CN III, IV, VI

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8
Q

CN involved in dysphagia and laryngeal paralysis

A

CN IX, X

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9
Q

How is GBS diagnosed?

A
  • CSF examination
  • Nerve conduction studies
  • MRI
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10
Q

T/F: GBS patient should exhibit UMN signs

A

false - Patient should NEVER have UMN signs

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11
Q

What is GBS characterized by?

A

motor weakness and diminished reflexes

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12
Q

What past patient history is common in GBS with a viral origin?

A

PMH of URI or GI infection within the last month

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13
Q

Required features for GBS

A
  • progressive, symmetrical weakness of legs and arms (sometimes initially only in the legs)
  • areflexia or decreased reflexes in weak limbs
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14
Q

supportive features for GBS

A
  • progression of symptoms < 4 weeks
  • relative symmetry
  • mild sensory symptoms/signs
  • CN involvements, especially bilateral facial nerve weakness
  • recovery starting 2-4 weeks after progression haults
  • autonomic dysfunction
  • pain
  • no fever at onset
  • elevated protein in CSF
  • electrodiagnostic abnormalities consistent w/ GBS
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15
Q

doubtful features for GBS

A
  • sensory loss > motor loss
  • marked, persistent asymmetry of weakness
  • bowel and bladder dysfunction at onset
    severe pulmonary dysfunction w/ little or no limb weakness on onset
  • fever on onset
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16
Q

What is the most common type of GBS?

A

AIDP - acute inflammatory demyelinating polyradiculoneuropathy

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17
Q

AIDP characteristics

A
  • progressive, symmetrical muscle weakness
  • absent or depressed DTRs
  • often with preceding illness
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18
Q

Miller-Fisher syndrome characteristics

A
  • ophthalmoplegia (paralysis or weakness of one or more of the eye muscles), ataxia, areflexia
  • 25% develop extremity weakness
  • more localized towards the face, neck, throat, and trunk
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19
Q

Which type of GBS leads to a lot of breathing, swallowing, and respiratory issues?

A

Miller-Fisher Syndrome

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20
Q

Acute motor axonal neuropathy (AMAN) characteristics

A
  • axonal involvement
  • muscle weakness with occasional preservation of DTRs
  • sensory spared
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21
Q

Acute motor-sensory axonal neuropathy (AMSAN) characteristics

A
  • axonal involvement
  • motor and sensory nerves impacted
22
Q

What is the goal of medical management of GBS?

A
  • Control inflammatory response, there is no cure
23
Q

What is thought to prevent further myelin loss and prevent axonal loss? - major intervention for GBS

A
  • Intravenous immunoglobulin (IVIg) – used to provide extra antibodies that your body cannot make on its own
24
Q

What is associated with reduced nerve damage and faster clinical improvement? - major intervention for GBS

A
  • Plasma Exchange (Plasmapheresis) – remove plasma and cells from blood then put cells back into blood and plasma is discarded
25
Q

characteristics of acute phase GBS

A
  • rapid progression of symptoms that peak after 2-4 weeks
26
Q

characteristics of the plateau phase of GBS

A
  • Nadir
  • stability of symptoms
  • may last only days, up to ~ a month
27
Q

characteristics of the recovery phase of GBS

A
  • gradual improvement of symptoms
  • gradual recovery of muscle strength 2-4 weeks after plateau
  • sensory disturbance and fatigue can persist for years
28
Q

What are some potential complications in the acute phases of GBS?

A
  • Respiratory impairment and failure; pneumonia
  • Autonomic instability
  • Pain
  • Prolonged hospitalization and immobility – DVT, skin breakdown, contracture
  • Relapse if treatment inadequate
29
Q

Which tests looks at the risk of developing respiratory failure in the 1st week of admission?

A

EGRIS

30
Q

Which tests is a prognostic scoring system to estimate the ability to walk at 6 months?

A

EGOS

31
Q

What prognostic indicators are used with the EGRIS?

A

Risk of developing respiratory failure in the 1st week of admission
- Days between onset of weakness and hospital admission
- Facial or bulbar weakness at time of admission
- UE/LE strength at time of admission

32
Q

What prognostic indicators are used with the EGOS?

A

prognostic scoring system used at 1 and 2 weeks after admission to estimate ability to walk at 6 months
- 1 week – Modified EGOS
o Age at onset
o Preceding diarrhea in the last 4 weeks
o UE/LE strength at day 7 of admission
- 2 weeks
o Age at onset
o Preceding diarrhea in last 4 weeks
o GBS disability score at 2 weeks after hospital admission

33
Q

GBS disability scale

A

7 point scale rating level of global disability
- 0 = healthy
- 1 = minor symptoms (can run)
- 2 = able to walk 10 m w/o assistance but can’t run
- 3 = able to walk 10 m w/ help
- 4 = bedridden or chair bound
- 5 = required assisted ventilation for at least part of day
- 6 = dead

34
Q

Overall Disability Sum Score (ODSS)

A
  • UE and LE functional tasks scored 0-12
    0 = no disability
    12 = severe disability

significant association with patient’s own perception of clinical condition

35
Q

Explain the major differences between GBS and CIDP.

A

Onset – slow and progressive for CIDP compared to rapid for GBS

Treatment – sustained treatment even with remission for CIDP vs rarely further deterioration after symptoms stabilize with GBS

36
Q

T/F: We expect cognitive delays with GBS

A

false - GBS is a peripheral disorder so we do not expect cognitive delays
- pt may have slurred speech because of cranial nerve dysfunction but not cognitive delay

37
Q

Early goals in hospital for GBS

A
  • maintain skin integrity - positioning, turning schedule, pt/family education
  • maintain ROM - positioning, PROM
  • chest PT
  • mobilization
  • patient education - what to expect?
  • frequent re-evaluation of MMT
38
Q

Are GBS or SCI patients more likely to develop contractures?

A

SCI has high tone = likely to develop contracture

GBS has low tone = unlikely to develop contracture (floppy)

39
Q

What is a great activity to incorporate closed chain UE strengthening?

A

sitting balance

40
Q

AAROM to muscles w/ _____ MMT for strengthening

A

3/5

41
Q

AROM to muscles w/ _____ MMT for strengthening

A

> 3/5

41
Q

What should be avoided during strengthening and functional training?

A
  • avoid eccentric exercise to muscles w/o antigravity strength
  • avoid stress to muscles w/o anti gravity strength
42
Q

Can you use FES w/ GBS?

A

No b/c it is a LMN injury - doesn’t do anything

43
Q

functional training treatment strategies

A
  • gait training with and without AD, various surfaces in household and community
  • incorporate activities relevant to life roles
44
Q

balance training treatment strategies

A
  • walking while carrying light objects, standing static and dynamic activities
  • balancing on various surfaces, with and without vision
45
Q

strengthening training treatment strategies

A
  • 60-80% of 1 RM for muscle groups > 3/5, 2x/week for major muscle groups
  • monitor for over work and fatigue
46
Q

aerobic training treatment strategies

A
  • interval walking, stationary bike
  • 60-80% HRmax, up to 20-30 minutes
  • energy conservation
47
Q

patient education treatment strategies

A
  • safety with gradual resumption of activities
  • self monitoring of vitals during exercise
48
Q

Which treatment is is recommended when a patient can not walk 10 m w/o assistance?

A

plasma exchange (plasmapheresis)

49
Q

Which outcome measure has a significant association with patient’s own perception of clinical condition?

A

Overall Disability Sum Score (ODSS)

50
Q

negative prognositic indicators for GBS

A
  • age at onset (> 60)
  • need vent support
  • rapid onset (< 7 days) prior to admission
  • History of GI (diarrhea)
  • an average distal motor response amplitude reduction to < 20% of normal

Neuro 2 (19 decks)

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