Red Book- GBS

Question 1

What is GBS

Answer 1

Acute

Inflammatory

Demyelinating

Polyneuropathy

Usually as an autoimmune repsonse to a preceding illness

Question 2

What illnesses predipose

Answer 2

Campylobacter
CMV, EBV,, HSV
URTI
Mycoplasma

Question 3

How does it present

Answer 3

Ascending

Flaccid

Symmetrical weakness

Dysreflxiea, altered sensation

Autonominc disturbance

Preceding illness

Severe intrascapular or back pain occassionally

Question 4

Differential diagnosis

Answer 4

Infection
	Botulism
	Diptheria
	Poliomyelitis
	Lyme

Other autoimmune
MG

Organophosphate poisoning

B12 def.

Critical illness polyneuropathy

Brainstem pathology

Transverse myelitis

Question 5

Types of GBS

Answer 5

AIDP - acute inflammatory demyelinating polyneuropathy

Miller Fischer Syndrome

Acute Motor Axonal Neuropathy

Acute Motor and Sensory Axonal Neuropathy

Question 6

Anitbody to AIDP

Answer 6

Anti GM2 ganglioside

Question 7

Antibody to Miller Fischer

Answer 7

Anti GQ1b ganglioside

Question 8

Investigation

Answer 8

Blood work up 
	Antibodies for c.jejuni, CMV, EBV, HSV, HIB, m.pneumonia
	Viral hep
	atypical pneumonia
	C.jejuni - stool
	Auto antibodies for differentiate

Neuroimaging - CT/MRI

LP - raised CSF protein

Spiro - VC - 20mls/kg —> ITU
15mls/ks —> Tube

Neurophysiology —> NCS

Other - B12, folate, TFT, urine porphyrins

Question 9

When to admit to ITU

Answer 9

Resp failure VC<20ml/lg

Bulbar weakness

Autonomic instability

Question 10

What is dysautonomia

Answer 10

Imbalance between symp and parasymp

More common in demyelinating rather than axonal GBS

Labile BP plus dysrhythmias

Progress to sinus arrest

Gastric empty also affected

Usually present when patient needs MV

Needs invasive monitoring and infusions of short acting —> esmolol, GTN, norad

Question 11

Treatment of GBS

Answer 11

ABCDE etc

Treat the GBS
IVIg - 0.4g/kg/day for 5 day
PLex

IVig is expensive but easier to administer and fewer side effect
PLex reduces need for symptom support and shortens recovery

No evidence one is better over other

NO ROLE FOR STEROIDS

Question 12

Points to note on intubation

Answer 12

Do it if VC<15ml/kg

Avoid sux - hyperkalaemia

NIV is limted and CI in bulbar palsy

Autonomic dysfunction —> increased asp risk

Question 13

General supportive measures

Answer 13

VTE
VAP bundles — head up, supraglottic suction, sedation hold, PPI, chlorhex

Gut - enteral feed, PPI, laxatives

Physio

Pressure and eye care

Analgesia with atypical - gabapentin

Psych

Question 14

Prognosis

Answer 14

80% good out come at 1 year
5% mortality

5-10% incomplete recovery and prolonged ICU stay

10% relapse

Question 15

Poor prognostic indicators

Answer 15

Need for MV
Axonal variant
Eldery
Significant neuro at presentation