Week 8 Guillian-Barre Syndrome Flashcards
what is GBS
an inflammatory autoimmune disorder of peripheral nerves leading to rapid developing motor deficits, (symmetrical ascending paralysis) and ANS dysfunction, sensory deficits and respiratory failure
what is the incidence of GBS, mortality, gender, race
1-2/100,000
2-3% mortality
men more then women
caucasian
what is the etiology of GBS
unknown, an autoimmune response, and an inflammatory response to infection, surgery or vaccine. illness within the last 30 days, and GI or URT within 1-3 weeks.
in 1976-1977 from the swine flu vaccine.
when does GBS peak
4 weeks from onset
describe the pathogenesis of GBS
inflammatory process, affecting Schwann cells, macrophages attack, and they are demyelinated. then there is lymphatic infiltration that can destroy axons too.
what is the rate of axonal regrowth and demyelination
1mm to 3-5mm/day
what is the presentation of GBS
rapid ascending symmetrical motor weakness and sensory deficits, flaccid paralysis, areflexia, diminished reflexes, numb and tingle stocking glove manner,
what percent needs mechanical ventilation
25-30%
the preganglionic fibers in the ANS are myelinated… what does this mean to us
tachycardia, BP changes and some vasomotor symptoms
what is the progression of GBS
50% cases progression stops in 2 weeks, and 80-90% cases, stops in 4 weeks
then there is a 4 week static phase, where nothing happens
recovery happens in the proximal to distal or distal to proximal
proximal to distal
how long dos it take to recover
65-85 % full recovery, in. months to years.
15-20% have disabilities
10% of cases recur
is depression and anxiety associated
yes, because you have limitations in movement and function but cognitively all still there
what are some poor prognostic indicators
older age, delayed onset of recovery, artificial respiration, command motor action potential less than 20% and diarrhea (campylobacter jejuni infection)
what does their recovery look like, in terms of time and where they stay
3-6 weeks IP
3-4 months OP rehab
up to 85% recovery
what are some other polyneuropathies (5)
- acute inflammatory demyelinating polyneuropathy (AIDP)
- acute motor axonal neuropathy (AMAN)
- acute motor sensory axonal neuropathy (AMSAN)
- miller-fisher syndrome
- chronic inflammatory demyelinating polyneuropathy (CIDP)
what is acute inflammatory demyelinating polyneuropathy (AIDP)
most common variant of GBS, progressive areflexic weakness and sensory changes, sensory before motor, but more motor deficits.
distal paresthesias and loss of DTRs
20% respiratory failure
what is acute motor axonal neuropathy
acute flaccid paralysis, areflexia, with sparing of sensory fibers. motor only. little to no signs of demyelination or inflammation, and antibodies bind to nodes ranvier and causes conduction block. Japan and china, and recovery is either rapid or slow, but good prognosis at one year potentially only the ventral roots)
what does wallerian degeneration require
axon regrowth
what is acute motor sensory axonal neuropathy
severe form of GBS, Asia, central American and South America. more rare than AMAN
may be ventral and dorsal roots.
distal weakness, loss DTR, sensory symptoms paresthesia and pain. reduced nerve condition velocity with decreased muscle activation and sensory nerve AP
poor prognosis
what is the difference between AMAN and ASMAN
AMAN: ventral roots only
ASMAN: dorsal and ventral roots
what is miller-fisher syndrome
only 5% GBS
paralysis, weakness of extra-occular muscles, ataxia, and areflexia
diplopia, slurred speech and swallowing issues
limb or gait ataxia, decreased proprioception, LE and UE weakness, and respiratory complications.
what is chronic inflammatory demyelinating polyneuropathy
1 in 500,000 per year
clinical presentation and diagnosis is like GBS
may extend over several years, or recurring, from multiple episodes.or a monosynaptic form of a single episode that extends over 1-3 years without a reoccurrence.
what is CIPD prognosis
faster diagnosis, leads to less disability
either active or progressive
can be stable in remission with or without disabilities
