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
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
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)
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
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
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
7
Q
CN involved in double vision
A
CN III, IV, VI
8
Q
CN involved in dysphagia and laryngeal paralysis
A
CN IX, X
9
Q
How is GBS diagnosed?
A
- CSF examination
- Nerve conduction studies
- MRI
10
Q
T/F: GBS patient should exhibit UMN signs
A
false - Patient should NEVER have UMN signs
11
Q
What is GBS characterized by?
A
motor weakness and diminished reflexes
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
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
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
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
16
Q
What is the most common type of GBS?
A
AIDP - acute inflammatory demyelinating polyradiculoneuropathy
17
Q
AIDP characteristics
A
- progressive, symmetrical muscle weakness
- absent or depressed DTRs
- often with preceding illness
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
19
Q
Which type of GBS leads to a lot of breathing, swallowing, and respiratory issues?
A
Miller-Fisher Syndrome
20
Q
Acute motor axonal neuropathy (AMAN) characteristics
A
- axonal involvement
- muscle weakness with occasional preservation of DTRs
- sensory spared
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
characteristics of acute phase GBS
- rapid progression of symptoms that peak after 2-4 weeks
26
characteristics of the plateau phase of GBS
- Nadir
- stability of symptoms
- may last only days, up to ~ a month
27
characteristics of the recovery phase of GBS
- gradual improvement of symptoms
- gradual recovery of muscle strength 2-4 weeks after plateau
- sensory disturbance and fatigue can persist for years
28
What are some potential complications in the acute phases of GBS?
- Respiratory impairment and failure; pneumonia
- Autonomic instability
- Pain
- Prolonged hospitalization and immobility – DVT, skin breakdown, contracture
- Relapse if treatment inadequate
29
Which tests looks at the risk of developing respiratory failure in the 1st week of admission?
EGRIS
30
Which tests is a prognostic scoring system to estimate the ability to walk at 6 months?
EGOS
31
What prognostic indicators are used with the EGRIS?
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
What prognostic indicators are used with the EGOS?
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
GBS disability scale
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
Overall Disability Sum Score (ODSS)
- 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
Explain the major differences between GBS and CIDP.
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
T/F: We expect cognitive delays with GBS
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
Early goals in hospital for GBS
- 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
Are GBS or SCI patients more likely to develop contractures?
SCI has high tone = likely to develop contracture
GBS has low tone = unlikely to develop contracture (floppy)
39
What is a great activity to incorporate closed chain UE strengthening?
sitting balance
40
AAROM to muscles w/ _____ MMT for strengthening
3/5
41
AROM to muscles w/ _____ MMT for strengthening
> 3/5
41
What should be avoided during strengthening and functional training?
- avoid eccentric exercise to muscles w/o antigravity strength
- avoid stress to muscles w/o anti gravity strength
42
Can you use FES w/ GBS?
No b/c it is a LMN injury - doesn't do anything
43
functional training treatment strategies
- gait training with and without AD, various surfaces in household and community
- incorporate activities relevant to life roles
44
balance training treatment strategies
- walking while carrying light objects, standing static and dynamic activities
- balancing on various surfaces, with and without vision
45
strengthening training treatment strategies
- 60-80% of 1 RM for muscle groups > 3/5, 2x/week for major muscle groups
- monitor for over work and fatigue
46
aerobic training treatment strategies
- interval walking, stationary bike
- 60-80% HRmax, up to 20-30 minutes
- energy conservation
47
patient education treatment strategies
- safety with gradual resumption of activities
- self monitoring of vitals during exercise
48
Which treatment is is recommended when a patient can not walk 10 m w/o assistance?
plasma exchange (plasmapheresis)
49
Which outcome measure has a significant association with patient's own perception of clinical condition?
Overall Disability Sum Score (ODSS)
50
negative prognositic indicators for GBS
- 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
