Neuro - Viva - Guillian Barre

Question 1

What is GBS

Answer 1

Acute
Inflammatory
Demyleinating
Polyneuropathy

Thought to be autoimmune repsonse to a preceding illness

CMV, EBCV, HSC, Mycoplasma

Question 2

How does GBS present

Answer 2

Ascending symmetrical flaccid weakness

Hypereflexia, disordered sensation, autonomic disturbance

May get lumbar back pain or intrascapular pain

Question 3

Diagnosis of weakness in general

Answer 3

Infective:
     Botulism
     Diptheria
     Polio
     Lyme

Autoimmune - Myasthenia gravis

Organophosphate poisoning

Porphyria

B12 deficiency

Brainstem patholohy

Critical illness neuromyopathy

Transverse myelitis/cord lesion

Electrolyte abnormalities

Question 4

Investigation of GBS

Answer 4

CT - MRI - Organic pathology and ICP

Lumbar puncture, isolated raised CSF protein

Spiro - ITU when <20ml/kg
Vent with <15ml/kg

Underlying causes:

Antibodies for C.jejuni, CMV, EBV, HSV, HIV, mycoplasma
Stool for campylobacter

Antibodies for subtypes

Other tests - B12 folate, TFT, urine porphyrins, drugs

Neurophysiology

Question 5

Types and antibodies for GBS

Answer 5

Acute inflammatory demyelinating poly - Anti GM2 ganglioside

Miller Fishcer - Anti GQ1b ganglioside - Opthalmoplegia

Acute motor axonal neuropathy - Non inflammatory without demyelination

Acute motor and sensory axonal neuropathy - directe at sensory nerves

Question 6

Criteria for admission/vent

Answer 6

VC<20ml/kg (15 for vent)
Low MIP

Bulbar weakness
Autonomic signs

Question 7

What are the autonomic signs

Answer 7

Labile BP
Dysrhytmias –> sinus arrest
Delated gastric emptying

Question 8

What does dysautonmia happen

Answer 8

Imbalance between symp and parasymp nervous systems

More common in the demyelinating form of GBS (as opposed to axonal)

Usually needs MV

May need short acting vasoactive meds
Esmolol/labetalol/GTN/norad

Question 9

Management

Answer 9

ABCDE

ITIg - 0.4g/kg/day for 5 days - 1st line

Plas Ex - best benefit when started within 7 days of symptoms, reduces need for resp support, shorter recovery

One is not better than another

Steroids not helpful

Question 10

Points to note about I&V

Answer 10

Do when VC < 15ml/kg

Risk of aspiration or bulbar palsy

Avoid Sux –> high K

NIV not useful and definatley not in bulbar palsy

May need early trachy

Question 11

Cardiac issues

Answer 11

Labile BP
Arrhytmias - treat promptly
Brady on suction/rolling

Question 12

General supportive issues

Answer 12

VTE
VAP bundles, head up, suproglottic suction, sedation holds
Gut care, feed, laxative (beware ileus)
Physio
Pressure care
Analgesia --> TCAs gabapentins
Pschy

Question 13

Prognosis of GBS

Answer 13

80% good at 1 year
5% mortality
5-10% incompete recovery
10% relapse

Question 14

Relapse rate

Answer 14

10%

Question 15

Mortaltiy

Answer 15

5%

Question 16

Predictors or poor prognosis

Answer 16

Needs MV
Axonal variant
Eldery
Significant neurlogy at presentation