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Gwen - Neurology > Peripheral nerve disease - Guillain Barre Syndrome and mononeuropathies > Flashcards

Peripheral nerve disease - Guillain Barre Syndrome and mononeuropathies Flashcards

1
Q

Name a mononeuropathy affecting a single nerve

A

Carpal tunnel

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2
Q

Name a process affecting multiple neuropathy

A

Mononeuritis multiplex

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3
Q

Causes of mononeuritis multiplex

A

Acute

  • Daibetes mellitus
  • Polyarteritis nodosum
  • Connective tissue diseases, e.g. SLE, Rheumatoid arthritis

Chronic

  • multiple compressive neuropathies
  • sarcoidosis
  • acromegaly
  • leprosy
  • Lyme disease
  • idiopathic
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4
Q

Causes of painful peripheral neuropathy

A

Diabetes mellitus

Alcohol

Vitamin B1 or B12 deficiency

Carcinoma

Porphyria

Arsenic or thallium poisoning

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5
Q

Cause of peripheral neuropathies

A
  • D Drugs and chemicals (Pb, phenytoin, metronidazole, amiodarone, hydralazine, vincristine, isoniazid, organic solvents, sulphonamides, nitrofurantoin, CO, OPs).
  • A alcohol (with or without Thiamine deficiency)
  • M metabolic (diabetes, hypoglycemia, uraemia)
  • I infection (HIV, leprosy, lyme, diptheria, syphilis) or post infectious (GBS)
  • T tumour (paraneoplastic phenomenon – lung, lymphoma, myeloma)
  • B B12 & other vitamin deficiency states, as well as pyridoxine excess
  • I idiopathic and infiltrative (e.g. amyloidosis)
  • T toxins (botulism, ciguatera, Tetrodotoxin, Saxitoxin, BRO, tick paralysis)
  • C connective tissue diseases (e.g. SLE, PAN, RhA) and congenital (e.g. CMT)
  • H Hypothyroidism
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6
Q

Most common causes of peripheral neuropathies

A

diabetes mellitus

amyloidosis

Guillain-Barre Syndrome

Paraneoplastic neuropathy (usually lung cancer)

Sogren’s syndrome-associated neuropathy

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7
Q

What is Guillain-Barre syndrome?

A

Acute demyelinating polyneuropathy

An acute inflammatory response which most-often occurs several weeks after viral infection, usually GI/GU.

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8
Q

How long after infection does paralysis occur in someone with Guillain-Barre syndrome?

A

1-3 weeks

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9
Q

What are causes of Guillain-Barre Syndrome?

A

Uusually triggered by infection (normally resp or GI infection)

  • Campylobacter jejuni
  • CMV
  • Mycoplasma
  • Herpes Zoster
  • HIV
  • EBV
  • Vaccination
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10
Q

Why does Guillain-Barre Syndrome occur?

A

Molecular mimicry, i.e. sharing of homologous epitopes between microorganism liposaccharides and nerve gangliosides (e.g. GM1), is the possible mechanism.

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11
Q

What are symptoms/signs of Guillain-Barre syndrome?

A

LMN lesion

  • Aymmetrical ascending muscle weakness
    • ​All 4 limbs
  • Autonomic dysfunction - Sweating, tachycardia, Hypertension, arrhythmias
  • CN involvement
    • ​Dysphasia
    • Dysarthria
  • Sensory loss
    • ​Glove and stocking
  • LMN signs
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12
Q

How long does it take for someone to enter the recovery phase of Guillain-Barre syndrome?

A

4-6 weeks

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13
Q

What proportion of those with Guillain-Barre syndrome develop respiratory and facial muscle weakness?

A

20%

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14
Q

What investigations might you do in someone with suspected Guillain-Barre syndrome?

A
  • Nerve conduction studies (slow conduction)
  • LP
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15
Q

What might nerve conduction studies show in someone with Guillain barre syndrome?

A

Slow conduction

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16
Q

What might LP investigation show in someone with Guillain-Barre syndrome?

A
  • Increased protein
  • Normal WCC
  • Normal Glucose
17
Q

What signs may indicate need for transfer to ITU in someone with Guillain-Barre syndrome?

A

Respiratory involvement

18
Q

How would you monitor for respiratory involvement in someone with Guillain-Barre syndrome?

A

4-hourly FVC

19
Q

How would you manage someone with Guillain-Barre Syndrome?

A
  • IVIg - 5 days - 2 weeks (immunosupression)
  • DVT prophylaxis - LMWH + compression stockings
  • Consider Plasma exchange

GBS:

  • Get tracheostomy kit
  • Begins in lower extremities
  • Start NIV
20
Q

What is the prognosis for someone with Guillain-Barre syndrome?

A

Good - 85% of individuals make near/complete recovery. Recovery takes time: anywhere between several days to 6 weeks.

21
Q

Typical sequence of events of pathology in onset of Guillain Barre

A

Acute inflammatory demyelination

Polyneuropathy

22
Q

Name 2 varients of GBS

A

Chronic Inflammatory Demyelinating Polyradiculopathy - characterised by a slower onset and recovery vesrsion of GBS.

Miller-Fischer Syndrome - Comprises of opthalmoplegia, ataxia, areflexia. Associated with anti-GQ1b antibodies in serum.

Gwen - Neurology (38 decks)

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