Guillain-Barre Syndrome (quick hits)

28 Apr

GBS:
-Primarily an acute inflammatory demyelinating polyneuropathy (AIDP)
-Often associated with prodromal infectious organisms:
            -Campylobacter jejuni (patients with diarrhea history)
            -CMV
            -EBV
            -Mycoplasma pneumonia

Cause:
-It is believed that macrophages attack antigens on the myelin sheath that are extremely similar to antigen on certain organisms
 

Symptoms:
Progressive, symmetrical distal weakness usually worse in the lower extremities (ASCENDING PARALYSIS)
-Associated with diminished DTRs
-Can affect all four extremities in up to 40% of cases
-Ocular muscles are usually spared in this disease 
 
Prognosis:
-Nearly one third require ventilator assistance during their course
-Peak disease severity is usually a weak after onset
 

Diagnosis:
-MRI imaging showing selective enhancement of the anterior spinal nerve roots
CSF fluid showing a very high protein with only a mild pleocytosis
-Electrophysiologic testing
 
Management:
Respiratory Assessment:
-FVC measurement is essential to determine the need for intubation/impending respiratory failure
-FVC less than 20ml/kg is associated with pending respiratory failure
-NIF less than 30cm H20 are also more likely to require intubation
 
Therapy
IVIG or plasma exchange are treatment of choices
 
Blood Pressure
-It is advised not to treat hypertension in GBS as the hypertensive stage is often followed by the hypotensive stage
 

Submitted by Joey Grover.
 References: Rosen’s Emergency Medicine: 7th Edition; picture

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