Guillian Barre Syndrome

Question 1

What is it?

Associated cause

Answer 1

Guillain-Barré syndrome is an “acute paralytic motor predominant polyneuropathy ” that affects the peripheral nervous system.

GBS is an ascending inflammatory demyelinating polyneuropathy.

It is usually triggered by an infection and is particularly associated with to campylobacter jejuni, cytomegalovirus and Epstein-Barr virus.

Question 2

Pathology

Answer 2

Molecular mimicry = The B cells of the immune system create antibodies against the antigens on the pathogen that causes the preceding infection.

These antibodies also match proteins on the nerve cells.

They may target proteins on the myelin sheath of the motor nerve cell or the nerve axon.

Question 3

Clinical Features

Answer 3

• Symmetrical ascending weakness (starting at the feet and moving up body)
• Reduced reflexes (LMN so no upgoing plantar)
• There may be peripheral loss of sensation or neuropathic pain
• It may progress to the cranial nerves and cause facial nerve weakness

Symptoms usually start within 4 weeks of the preceding infection

Question 4

Diagnosis

Answer 4

A diagnosis of Guillain-Barré syndrome is made clinically. The Brighton criteria can be used for diagnosis.

Diagnosis can be supported by investigations:
- Nerve conduction studies (reduced signal through the nerves)

• Lumbar puncture for CSF (raised protein with a normal cell count and glucose)

Question 5

Management

Answer 5

IV immunoglobulins

Plasma exchange

Supportive care

VTE prophylaxis (pulmonary embolism is a leading cause of death)

In severe cases with respiratory failure patients may need intubation, ventilation and admission to the intensive care unit.