Neurology - Guillain Barre syndrome

Question 1

What is GBS?

Answer 1

An acute paralytic polyneuropathy that affects the peripheral nervous system

Question 2

What triggers GBS?

Answer 2

Often triggered by an infection

Particularly associated with:

• Campylobacter jejuni (most common
• CMV
• EBV

Question 3

What is the pathophysiology of GBS?

Answer 3

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 4

How does GBS typically present?

Answer 4

Symmetrical ascending weakness (starting at feet typically)

Reduced reflexes

May have:

• Peripheral loss of sensation
• Neuropathic pain
• Facial nerve weakness (if it has progressed to cranial nerves)

Typically within 4 weeks of preceding infection

Symptoms peak within 2-4 weeks and can take months-years to fully resolve

Question 5

How is diagnosis of GBS made?

Answer 5

Diagnosis is made clinically (can use the Brighton criteria)

Diagnosis can be supported with investigations:

• Nerve conduction studies
• Lumbar puncture for CSF (raised protein with normal cell count and glucose)

Question 6

Management of GBS

Answer 6

IVIG - first line
Supportive care
VTE prophylaxis (PE is a leading cause of death)

Plasma exchange (an alternative to IVIG)

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

Question 7

Prognosis of GBS

Answer 7

80% will fully recover

15% will be left with some neurological disability

5% will die