Week 8 Guillian-Barre Syndrome

Question 1

what is GBS

Answer 1

an inflammatory autoimmune disorder of peripheral nerves leading to rapid developing motor deficits, (symmetrical ascending paralysis) and ANS dysfunction, sensory deficits and respiratory failure

Question 2

what is the incidence of GBS, mortality, gender, race

Answer 2

1-2/100,000
2-3% mortality
men more then women
caucasian

Question 3

what is the etiology of GBS

Answer 3

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.

Question 4

when does GBS peak

Answer 4

4 weeks from onset

Question 5

describe the pathogenesis of GBS

Answer 5

inflammatory process, affecting Schwann cells, macrophages attack, and they are demyelinated. then there is lymphatic infiltration that can destroy axons too.

Question 6

what is the rate of axonal regrowth and demyelination

Answer 6

1mm to 3-5mm/day

Question 7

what is the presentation of GBS

Answer 7

rapid ascending symmetrical motor weakness and sensory deficits, flaccid paralysis, areflexia, diminished reflexes, numb and tingle stocking glove manner,

Question 8

what percent needs mechanical ventilation

Answer 8

25-30%

Question 9

the preganglionic fibers in the ANS are myelinated… what does this mean to us

Answer 9

tachycardia, BP changes and some vasomotor symptoms

Question 10

what is the progression of GBS

Answer 10

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

Question 11

recovery happens in the proximal to distal or distal to proximal

Answer 11

proximal to distal

Question 12

how long dos it take to recover

Answer 12

65-85 % full recovery, in. months to years.
15-20% have disabilities
10% of cases recur

Question 13

is depression and anxiety associated

Answer 13

yes, because you have limitations in movement and function but cognitively all still there

Question 14

what are some poor prognostic indicators

Answer 14

older age, delayed onset of recovery, artificial respiration, command motor action potential less than 20% and diarrhea (campylobacter jejuni infection)

Question 15

what does their recovery look like, in terms of time and where they stay

Answer 15

3-6 weeks IP
3-4 months OP rehab
up to 85% recovery

Question 16

what are some other polyneuropathies (5)

Answer 16

• acute inflammatory demyelinating polyneuropathy (AIDP)
• acute motor axonal neuropathy (AMAN)
• acute motor sensory axonal neuropathy (AMSAN)
• miller-fisher syndrome
• chronic inflammatory demyelinating polyneuropathy (CIDP)

Question 17

what is acute inflammatory demyelinating polyneuropathy (AIDP)

Answer 17

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

Question 18

what is acute motor axonal neuropathy

Answer 18

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)

Question 19

what does wallerian degeneration require

Answer 19

axon regrowth

Question 20

what is acute motor sensory axonal neuropathy

Answer 20

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

Question 21

what is the difference between AMAN and ASMAN

Answer 21

AMAN: ventral roots only
ASMAN: dorsal and ventral roots

Question 22

what is miller-fisher syndrome

Answer 22

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.

Question 23

what is chronic inflammatory demyelinating polyneuropathy

Answer 23

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.

Question 24

what is CIPD prognosis

Answer 24

faster diagnosis, leads to less disability
either active or progressive
can be stable in remission with or without disabilities