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Guillain Barre Syndrome Symptoms

    View: 
Background:



?1859- Landry published a report on 10 patients with ascending paralysis

?1916- Guillain, Barre and Strohl described 2 French soldiers with motor weakness, areflexia, and ?albuniocytological dissociation? in the cerebrospinal fluid. They recognized the peripheral nature of the illness

Epidemiology:

?1-3 per 100,000 (US)

?M:F ? 1.5:1

?Ages: bimodal distribution with 2 peaks (15-35 yrs) & (50-75 yrs)

Etiology:

?Post-infectious AI disease

?Cellular and humoral mechanisms

?Association with administration of certain vaccinations, and other systemic illnesses

Auto-immunity In GBS

?Humoral immunity: antibodies formed against capsular antigens cross-react with myelin

?Target: gangliosides and glycolipids, such as GM1 and GD1b, distributed throughout the myelin in the peripheral nervous system

?Lmphocytic infiltration of spinal roots and peripheral nerves, followed by macrophage-mediated multifocal stripping of myelin

?Sub-group: primary immune attack directly against nerve axons

Variants:

?Miller-Fisher syndrome: ataxia, ophthalmoplegia, and areflexia. Anti-GQ1b antibodies (ophthalmoplegia)

?Acute motor axonal neuropathy (AMAN): pure motor axonopathy. Pediatric age groups

?Acute motor-sensory axonal neuropathy (AMSAN): axonal degeneration of motor and sensory nerve

?Pure sensory variant of GBS

?Acute pandysautonomia: postural hypotension, bowel and bladder retention, anhidrosis

Common Infectious Agents:

?Bacteria: C jejuni (60% in north China study), Haemophilus influenzae, Mycoplasma pneumoniae, and Borrelia burgdorferi

?Viruses: cytomegalovirus (13% in Dutch Study), Ebstein-Barr virus and HIV

Other Associations:

?Vaccines: group A streptococci vaccines, the rabies vaccine, and the swine flu vaccine

?Systemic illnesses: systemic lupus erythematosus, sarcoidosis, lymphoma, surgery, renal transplantation (ANECDOTAL)

Presentation:

?History - Antecedent illness

- Weakness (ascending and symmetrical)

- Sensory changes (ascending paraesthesias)

- CN involvement ( Facial droop, Diplopias, Dysarthria, Dysphagia)

- Pain (Back & leg)

- Autonomic changes

- Respiratory involvement

?Preceding illness

?2/3 of patients

?URTI or GI symptoms

?1-3 weeks prior to onset

?C jejuni- can cause both URTI or GI symptoms

?Weakness

?Classic clinical picture is ascending and symmetrical

?Develops over days to weeks

?Can very from mild to tetraplegia

?Peaks 4 weeks after onset

?Recovery 2-4 weeks after peak

?Sensory change

?Frequently ascending as well

?Parasthesia, numbness.

?Usually mild

?Cranial nerve involvement

?45-75% of patients

?Facial drop

?Diplopia

?Dysarthria

?Dysphagia

?Pain

?89% of one study experienced pain

?50% of these severe and distressing

?Back and leg pain

?Autonomic symptoms

?Tachycardia, bradycardia

?Urinary retention

?Sweating

?Respiratory involvement

?40% of patients

?Exertional dyspnea

?SOB

?Slurred speech

?Ventilatory arrest

Physical

?Tachycardia/bradycardia, tachypnea

?BP lability

?Lower extremities first affected

?If marked asymmetry then ???GBS

?Weakness

?Hyporeflexia or absent reflexes

?Normal objective sensory exam

?If marked then ??? GBS

?CN: facial weakness, also VI,III,XII,IX,X

Investigations:

?CSF studies- CSF protein (>0.55 g/L) without an elevation of white blood cells (<10 lymphocytes/mm3)

?EMG / NCV - demyelination: nerve conduction slowing

- Axonal variant: absent or markedly reduced distal compound muscle action potentials (CMAP)

? Pulmonary Function tests- Max Insp. Pressure, VC

Management:

?Constant vigilant monitering

?Rehab

?Physical

?Speech

?Mental

?Respiratory support

?Immune therapy

Monitoring

?Monitor

?RR

?Vitals

?ABG

?PFT

?Pressure sores, DVT prophylaxis

?Enteric/Parenteral feedings

?Requires SCU/ICU admission

Immunotherapy:

Plasmapheresis

?IVIG- blocks macrophage receptors, inhibits antibody production, complement binding, and neutralizes pathologic antibodies

Prognosis:

?Most patients (up to 85%) with GBS achieve a full and functional recovery within 6-12 months

?7-15% of patients have permanent neurologic sequelae

?Mortality rate less than 5%
Guillain Barre Syndrome Symptoms
Guillain-Barre syndrome (also known as acute inflammatory or post-infective polyradiculoneuropathy) is a rare but serious disease of the peripheral nervous system. GBS can affect anybody. It can strike at any age and both are equally prone to the disorder. It often follows a minor infection, usually a respiratory (lung) infection or gastrointestinal (gut) infection. It can become life-threatening if the respiratory muscles are affected. GBS is believed to result from an autoimmune response, both humoral and cell mediated, to a recent infection or any of a long list of medical problems. The syndrome may occur at any age, but is most common in people of both between the ages 30 and 50. It is frequently severe and usually exhibits as an ascending paralysis noted by weakness in the legs that spreads to the upper limbs and the face along with complete loss of deep tendon reflexes. Adults are more commonly affected than children. Otherwise, recovery takes several months, but most people recover almost completely. In some cases, GBS can be fatal. The first symptoms of this disorder include varying degrees of weakness or tingling sensations in the legs. In many instances, the weakness and abnormal sensations spread to the arms and upper body. It may occur within days or weeks after a viral infection such as influenza (flu) or diarrhea. It may be triggered by pregnancy or a medical procedure, such as a vaccination or minor surgery, or have no evident reason for developing. Because the cause of GBS is unknown, there's no way to prevent the disease from occurring.

The most compelling case for a direct relation between the Guillain-Barre Syndrome and preceding infections derives from experience with the enteric pathogen Campylobacter jejuni.Guillain-Barr? occurs a few days or weeks after the patient has had symptoms of a respiratory or gastrointestinal viral infection. In most cases of Guillain-Barre syndrome the person had a virus or bacterial infection in the last four weeks. The disorder can develop over the course of hours or days, or it may take up to three to four weeks. Usually Occasionally, surgery or vaccinations will trigger the syndrome. In its most severe form, GBS is a medical emergency and may require hospitalization. The inflammation usually affects the nerve's covering. Such damage is called demyelination. Some CIDP patients experience periods of worsening and improvement, and individual relapses are often confused with GBS. Some primary care physicians have described patients who complained of mild brief tingling and/or limb weakness accompanying or following a viral illness, such as a sore throat or diarrhea. Such a set of symptoms may represent a very mild form of GBS. Most people recover from even the most severe cases of GBS. There are several types of GBS, but unless otherwise stated, GBS refers to the most common form, acute inflammatory demyelinating polyneuropathy. People with severe GBS often need long-term rehabilitation to regain normal independence, and as many as 15 percent experience lasting physical impairment.

Causes of Guillain-Barre syndrome

The common causes and risk factor's of Guillain-Barre syndrome include the following:

The exact cause of Guillain-Barre syndrome is unknown.

Infectious mononucleosis.

Administration of certain vaccinations, and other systemic illnesses.

Porphyria (rare disease of red blood cells).

Viral infections include cytomegalovirus, Ebstein-Barr virus, and during seroconversion with the human immunodeficiency virus.

Bacterial infections include C jejuni, Haemophilus influenzae, Mycoplasma pneumoniae, and Borrelia burgdorferi.

Symptoms of Guillain-Barre syndrome

Some sign and symptoms related to Guillain-Barre syndrome are as follows:

The first symptoms of GBS are usually numbness or tingling (paresthesia) in the toes and fingers.

Weakness, tingling or loss of sensation that often begins in your feet and legs and spreads to your upper body and arms.

Difficulty with eye movement, facial movement, speaking, chewing or swallowing.

Sensation changes.

Numbness, decreased sensation.

Drooling.

Difficulty breathing.

Difficulty moving face muscles.

Clumsiness and falling.

Tingling sensations.

Treatment of Guillain-Barre syndrome

Here is list of the methods for treating Guillain-Barre syndrome:

Plasmapheresis (plaz-muh-fuh-RE-sis): This treatment- also known as plasma exchange- is a type of "blood cleansing" in which damaging antibodies are removed from your blood.

High-dose immunoglobulin therapy is another procedure used to reduce the severity and length of Guillain-Barre symptoms.

ABCs, IV, oxygen, and assisted ventilation may be indicated.

In high-dose immunoglobulin therapy, doctors give intravenous injections of the proteins that, in small quantities, the immune system uses naturally to attack invading organisms.

Your treatment also may include pain medications including acetaminophen and nonsteroidal anti-inflammatory drugs, possibly in combination with narcotic painkillers.

Proper body positioning or a feeding tube may be used to prevent choking during feeding.

Blood thinners may be used to prevent blood clots.
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About Author
Both Ibrahim Lodhi & Juliet Cohen are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.

Ibrahim Lodhi has sinced written about articles on various topics from Religion, Nutrition and Pets. Dr. D.S. Merchant is a Gold Medalist in (Anatomy & Histology), Resident AKUH, Pakistan. For more information on Gastroenterology or visit
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