Guillian Barre syndrome Flashcards
What is GBS
Immune process cellular mimicry attacking myelin sheathe (antibodies to ganglosides) of multiple nerves
Classical features GBS
GI/resp infection 2-3 weeks before
Paraesthesia lower limbs, no sensory loss
Symmetrical LMN ascending weakness lower limbs > upper
What is the most common Acute inflammatory demyelinating polyneuropathy
GBS
Most common bacteria causing GBS
Campylobacter jejuni
Presentation GBS
- Mild paraesthesia of lower limbs
- Progressive weakness starts in lower limbs progressing to upper limbs
- Flaccid paresis with areflexia
- Often no sensory deficit
- Back or leg pain - nerve root inflammation
-Autonomic symptoms
Autonomic symptoms in GBS
Early - sus spinal cord lesion/cauda equina
Bladder and bowel v late disease
Sudden changes in BP/HR - rare
When is the peak of GBS?
2 weeks
Phases of GBS
Worsen over 2 weeks then plateau. Dramatic recovery at least 28 dyas after onset and plateau phase
Prognosis GBS
Majority -> normal function
Some have residual deficit eg fatigue, weak
What is so dangerous about GBS?
Resp muscle involvement
-> resp failure
Why is FVC vital analysis in GBS?
Neuromuscular resp failure can cause death / ICU admission
Most useful prognostic indicator for ventilation (reducing O2 occurs much later)
Variants of GBS
Sensory symptoms only
Axonal injury
Miller-Fischer syndrome
What can you test for in GBS on blood tests
Raised CK, abnormal LFTs
Inflam markers + biochem
Anti-gangloside antibodies (specific GBS variants)
Investigations GBS
Bloods - baseline, CK, LFTs, inflam markers, anti-gnagloside abs
Lumbar punture
Nerve conduction studies, EMG
What find on LP in GBS?
Albuminocytologic dissociation
Elevated protein but little to no cells
When does an LP for GBS become positive
More than 7 days after presentation
Treatment for GBS
Plasmapheresis eg plasma exchange
IV IgG
Supportive management GBS
Changes to HR and BP treat
Catheterise if urinary retnetion
Laxatives for constipation risk
VTE risk - prophylactic anticoag
Nutritional support
When consider ICU from FVC
<20ml/kg
Most important investigation GBS
FVC - resp muscles test
Signals problems before hypoxia and type 2 resp failure
