Neurology - Guillain-Barré Syndrome

Question 1

What is Guillain-Barré syndrome?

Answer 1

Acute paralytic polyneuropathy that affects the peripheral nervous system

Causes acute, symmetrical ascending weakness, can also cause sensory symptoms

Question 2

What are the common triggers of Guillain-Barré syndrome?

Answer 2

• Campylobacter jejuni
• Cytomegalovirus (CMV)
• Epstein-Barr virus (EBV)

Question 3

What is the mechanism thought to underlie Guillain-Barré syndrome?

Answer 3

Molecular mimicry

B cells create antibodies against antigens of the pathogen

Antibodies also match proteins on peripheal neurones

Antibodies then can target proteins on the myelin sheath or nerve axon

Question 4

What are the characteristic features of Guillain-Barré syndrome?

Answer 4

• Symmetrical ascending weakness
• Reduced reflexes

Question 5

How do symptoms of Guillain-Barré syndrome typically progress?

Answer 5

They start in the feet and progress upward, peaking within 2-4 weeks

Question 6

What additional symptoms may occur in Guillain-Barré syndrome?

Answer 6

• Peripheral loss of sensation
• Neuropathic pain
• Facial weakness
• Autonomic dysfunction (urinary retention, ileus, heart arrhythmias)

Question 7

What criteria are used for the clinical diagnosis of Guillain-Barré syndrome?

Answer 7

Brighton criteria

Question 8

What investigations support the diagnosis of Guillain-Barré syndrome?

Answer 8

• Nerve conduction studies (showing reduced signal)
• Lumbar puncture (showing raised protein with normal cell count and glucose)

Question 9

What is the first-line treatment for Guillain-Barré syndrome?

Answer 9

IV immunoglobulins (IVIG)

Supportive care
VTE prophylaxis
Plasmapheresis (alternative to IVIG)

Question 10

What is a leading cause of death in Guillain-Barré syndrome patients?

Answer 10

Pulmonary embolism

Question 11

What may severe cases of Guillain-Barré syndrome require?

Answer 11

Intubation, ventilation, and admission to the intensive care unit

Question 12

What is the prognosis for recovery in Guillain-Barré syndrome?

Answer 12

Recovery can take months to years, with patients regaining function up to five years after the acute illness

Question 13

What percentage of patients experience mortality from Guillain-Barré syndrome?

Answer 13

Around 5%

80% fully recover
15% some disability

Question 14

What are the main causes of mortality in Guillain-Barré syndrome?

Answer 14

• Respiratory complications
• Cardiovascular complications