guillian barre syndrome Flashcards
what is guillian barre syndrome?
an acute demyelinating polyneuropathy
how does the classic guillian barre patient present?
viral infection or diarrhoe prodrome (75%)
few weeks later becomes weak over days
first legs than arms
mild sensory changes
can be facial, bulbar and/or respiratory weakness
signs of lower motor neuron dysfunction
what does lower motor neuron dysfunction indicate in guillian barre?
acute neuropathy
what does the LP for guillian barre show?
high protein
what does the NCS for guillian barre show?
demyelination
what are the LMN lower motor neurone problem sings
decreased tone
distally weak (sometimes pyramidal)
absent reflexes
absent clonus
plantar responses flexor or absent
what is chronic inflammatory demyelinating polyneuropathy?
chronic demyelinating neruopathy similar to guillain barre
how does CIDP, chronic inflammatory demyelinating polyneuropathy typically present?
similar to GBS but slower
with relapses
not usually prodrome (ie diarrhea) OR resp failure
LMN signs
LP high protein, NCS demyelination
ICP headaches
facial weakness and opthalmoparesis
how is CIDP treatable?
immunosurpressants
good evidence for steroids (lancet 2006)
steroid sparing agents may be useful
IViG
in what ways is CIDP different to guillian barre?
doesnt usually occur with prodrome
is chronic rather than acute
autonomic dysfunction
GBS does not respond to steroids
what point is nadir in CIDP and GBS?
guillian barre 8 weeks
what tree conditions could be used to describe the continuum between GBS and CIDP
acute inflammatory demyelinating polyneuropathy (AIDP)
subacute inflammatory demyelinating polyneuropathy (SIDP)
chronic inflammatory demyelinating polyneuropathy (CIDP)
how is guillian barre treatable?
with IViG
supportive care
NG feeding
steroids ineffective
what is the incidence of guillian barre?
2 per 100,000
specifically, how does GBS present?
ascending symmetrical weakness hours to days
pain 2/3
LMN signs +/- mild sensory signs
facial weakness
respiratory weakness
bulbar involvement
CVS instability
sphincter signs
what are the GBS mimics?
acute spinal cord lesion
crtical illness polyneuropathy
CIDP
HIV, lyme (rare)
what are the GBS chameleons?
AMAN
AMSAN
miller-fisher syndrome
what tests should be performed for GBS and CIDP?
lumbar puncture
nerve conduction study (demyelination)
MRI (Exclude cord lesions)
infective serology
in rare cases what antibody can be testes for in guillian barre?
ganglioside antibodies
what happens to the F wave in GBS?
delayed
what is prognosis for GBS?
most patients fully recover
residual disability
what age does CIDP mostly affect?
any age but mostly 40-60
what is the incidence of CIDP?
1:200,000
what two types of CIDP are they?
relapsing and progressive
what is the pathogenesis of GBS?
T cells mistake myelin as foreign
linterleukin2 involved
cytokines attact macrophages which attack myelin
