Gullian Barre Syndrome

Question 1

Define:

Answer 1

Acute inflammatory de-myelinating polyneuropathy

Question 2

Aetiology/risk factors:

Answer 2

An inflammatory process following an infection where antibodies react to self- antigens on the myelin

Triggers: Campylobacter jejuni, CMV, mycoplasma, zoster, HIV, EBV, vaccinations) and malignancy cause antibodies.

Question 3

Epidemiology:

Answer 3

UK incidence 1-2/100,00 per year

Affects all ages

Question 4

Symptoms:

Answer 4

• PROGRESSIVE symptoms
• BILATERAL, near symmetry of symptoms
• < 1 month duration of:
o ASCENDING symmetrical limb weakness (lower > upper)
o ASCENDING paraesthesia
• Cranial nerve involvement (leading to, dysphagia, dysarthria, facial weakness)
• Respiratory muscles may be affected in SEVERE cases
• Pain common
• Autonomic dysfunction: sweating, raised pulse, BP changes, arrhythmias, urinary incontinence or constipation

Question 5

Signs:

Answer 5

Motor:
o Hypotonia
o Flaccid paralysis
o Arreflexia (ascending upwards from feet to head)

Sensory:
o Impairment of sensation in multiple modalities (ascending from feet to head)

Cranial Nerve Palsies
o Facial nerve weakness
o Abnormality of external ocular movements

• Type II Respiratory Failure
o Due to paralysis of respiratory muscles

Autonomic Function
o Assess postural blood pressure change and arrhythmias

Question 6

Investigations:

Answer 6

• Lumbar Puncture (CSF)
o HIGH protein
o NORMAL white cell count and glucose

Nerve Conduction Study
o Reduced conduction velocity
o NOTE: it may be normal in the early stages of the disease

Bloods
o Anti-ganglioside antibodies in Miller-Fisher variant + 25% of Guillain-Barre cases

Spirometry
o Reduced fixed vital capacity - suggests ventilatory weakness

ECG
o Arrhythmias may develop