lower limb weakness Flashcards
what is Gullian Barre syndrome
acute inflammatory neuropathy radiculo-neuropathy: root, plexus, peripheral nerves
what is spinal shock
very acute cord disease, in a patient with UMN problems they initially get normal tone and absent reflexes and later get increased tone and brisk reflexes
presentation of Gullian barre
acute/subacute presentation: peak by 4 weeks/ 4-8 weeks
preceding infection symmetrical ascending muscle weakness - mainly motor symptoms, can have sensory areflexia/hyporeflexia respiratory distress speech problems paraesthesia back/leg pain plantar reflex goes down autonomic dysfunction: sweating labile BP, arrhythmias, increased pulse no sphincter disturbance facial weakness
investigations required in Guillian Barre
full neurological exam
bloods:
B12 - treatable cause of
FBC - infection or anaemia
U&Es - electrolyte disturbances can cause muscle weakness
CA, Phosphate, Mg
ESR, CRP - inflammation/underlying infection
LFTs
LP - elevated protein, maybe slightly elevated lymphocytes
nerve conduction studies - shows slowing of nerves
FVC - decreased if in respiratory distress
ABG if required - CO2 retention
if breathless - ECG, CXR, D-dimer
diagnosis of GB
progressive weakness of all four limbs
areflexia
symmetrical weakness
use nerve conduction studies for evidence
management of GB
DVT and PE prophylaxis
may require ventilation - suspect if breathlessness worse when lying flat (due to weak diaphragm), limb weakness worsening, neck feels weaker, reduced chest exclusion of inspiration, co2 retention
IV immunoglobulin - IVIG
plasma exchange
CSF for GB
often normal in early stages
don’t usually see many cells <10
normal cell and glucose counts
raised protein
triggers of GB
viral - CMV, HIV
bacteria - campolabacter
systemic illness - Hodgkins
Pregnancy
lots of other stuff
prognosis of GB
mortality 3-5%
15% severe disability
80% recover in 6 months
