INFLAMMATORY DEMYELINATING NEUROPATHIES Flashcards
What is Guillain-Barre syndrome?
Weakness of the limbs as a result of an acute polyneuropathy, a disorder affecting the peripheral nervous system. Usually triggered by an infection, which provokes immune-mediated nerve dysfunction.
What types of infections usually precede a diagnosis of Guillain-Barre syndrome?
Respiratory infection
Diarrhoea
What bacteria has been particularly associated with Guillain-Barre syndrome?
Campylobacter jejuni
How long after the infection do patient’s tend to start experiencing symptoms of Guillain Barre syndrome?
1-3 weeks
Which virus has been particularly associated with Guillain Barre syndrome?
Cytomegalovirus
What are the classical features of Guillain Barre syndrome?
Distal parasthesia (often with no sensory loss) Proximal or generalized weakness Facial weakness (often asymmetrical) Back pain Muscle pain Pain in neck and head
What is the time course of disease progression in Guillain Barre syndrome?
Symptoms ascend up lower limbs and body over days to weeks - often reaching a peak within 6 weeks
Plateau phase where disease persists but at a stable level
Recovery over many months
What is the pattern of affected muscles in Guillain Barre syndrome?
Symmetrical weakness in arm and legs, and possible neck involvement
50% have some cranial nerve involvement - leading to eye problems, problems using face muscles and dysphagia.
How long does the plateau phase of Guillain Barre syndrome tend to last for?
Median time is a week
What are the classical signs of Guillain Barre syndrome that would be elicited on examination?
Reduced power
Reduced or absent reflexes
What are the most worrying complications of Guillain Barre syndrome?
Weakness of breathing leading to respiratory failure, as well as infection.
Autonomic dysfunction leading to arrythmias
PE from not moving
What is the treatment for those with respiratory failure as a result of Guillain Barre syndrome?
Intubation of the windpipe and breathing support through mechanical ventilation, generally on an intensive care unit.
How might you be able to anticipate the need for ventilatory support in a patient with Guillain Barre syndrome?
Measurement of two spirometry-based breathing tests: the forced vital capacity (FVC) and the negative inspiratory force (NIF). An FVC of less than 15 ml per kilogram body weight or an NIF of less than 60 cmH2O are considered markers of severe respiratory failure.
Other than respiratory failure, what other serious complications do a proportion of Guillain Barre syndrome patients experience?
Autonomic dysfunction
What are the autonomic complications associated with Guillain Barre syndrome, affecting up to 60% of patients?
Severe blood pressure fluctuations Irregularities in the heart beat, sometimes to the point that the heart beat stops and requiring pacemaker-based treatment. Abnormalities in perspiration Changes in the pupillary response Urinary retention Constipation