13) GBS

Question 1

GBS

Answer 1

Autoimmune disorder characterized by antibody-mediated demyelination

Question 2

Why is the fact that schwann cells are spared w/GBS a good thing?

Answer 2

Allows for future recovery & re-myelinization

Question 3

GBS is the most common cause of what?

Answer 3

• Rapidly evolving motor paresis
• Paralysis
• Sensory deficits

Question 4

What pop is GBS most common in?

Answer 4

Male young adults & people btwn ages 50-80

Question 5

Sx’s of GBS

Answer 5

• Flaccid paralysis
• Areflexia
• Respiratory compromise
• Autonomic dysfxn

Question 6

Explain the pathogensis of GBS

Answer 6

• Schwann cells get attacked by the immune system
• Inflammatory response is initiated–>Lymphocytes & macrophages
  
  • Macrophages strip myelin starting at the node of ranvier
• Schwann cells divide & remyelinate nerves

Question 7

W/flaccid paralysis, when does max weakness occur?

Answer 7

2-3wks after onset

Question 8

What occurs in 50% of cases of fllaccid paralysis

Answer 8

Muscle weakness

Question 9

What can pharyngeal & laryngeal weakness cause?

Answer 9

Dysphagia & subsequent aspiration

Question 10

What occurs w/autonomic dysfxn?

Answer 10

• BP & HR fluctuations
• Excessive/No sweating
• Flusing of face

Question 11

Classic GBS (AIDP)

Answer 11

Acute Inflammatory Demyelinating Polyrediculoneuropathy

Question 12

Describe the devo & progression of sx’s of AIDP

Answer 12

Fast from distal to proximal in a “stocking glove” manner

Question 13

What other patho’s need to be r/o when dx’ing AIDP?

Answer 13

• NMJ Pathos
  
  • Tick neuropathy
  • Toxic neuropathy
  • Myasthenia gravis
  • Neuromuscular blocking agents
• CNS Pathos
  
  • Transverse myelitis
  • ASA syndrome
  • Polio
• CVA
• Metabolic disoders

Question 14

NIH Criteria for Dx of GBS

Answer 14

• Progressive, symmetric weakness in >1 limb
• Loss of DTR
• Sensory deficitd
• Decr NCV
• Tachycardia
• Arrythmia
• Labile BP
• 1wk LP w/incr albumin & decr WBC
• No fever

Question 15

Is GBS a medical emergency?

Answer 15

Can be

Question 16

Medical Management of GBS

Answer 16

• Tx aimed at controlling the autoimmune response
• Plasmapheresis to decr time on vent
• IVIg

Question 17

Are corticosteroids effective for tx’ing GBS?

Answer 17

No

Question 18

When does recovery of GBS begin?

Answer 18

2-4wks after peak impairment

Question 19

What is the static phase?

Answer 19

Time between peak impairment & recovery

Question 20

How does GBS recovery occur?

Answer 20

From proximal to distal

Question 21

How long does GBS recovery take?

Answer 21

Wks to yrs

Question 22

Factors for a Good Prognosis

Answer 22

• Younger age at onset
• Shorter static phase
• Inact axons
• Less total impairment
• No need for mechanical ventilation

Question 23

Factors for Poor Prognosis

Answer 23

• Advanced age at onset
• Longer static phase
• Need for mechanical vent
• Evidence of axonal degeneration

Question 24

AMAN

Answer 24

Acute Motor Axonal Neuropathy

Question 25

AMSAN

Answer 25

Acute Motor & Sensory Axonal Neuropathy

Question 26

Acute Autonomic Neuropathy

Answer 26

Postural hypotension, impaired sweating, & impaired B&B

Question 27

CIDP

Answer 27

Chronic Inflammatory Demyelinating Polyneuropathy

Question 28

Chronic Inflammatory Demyelinating Polyneuropathy

Answer 28

Chronic counterpart to GBS, but sx's are more difuse, progression is slower, & can relapse-remit

Question 29

Who is CIDP more commonly dx'ed in?

Answer 29

Women & Young adults

Question 30

If GBS goes un-dx'ed, what can happen?

Answer 30

Severe permanent nerve damage

Question 31

Tx for GBS

Answer 31

Corticosteroids w/ or w/o immunosuppressants

Question 32

Long-term consequences of GBS tx

Answer 32

* Mood swings * Fluid retention * Incr BP * Fx * OP * Bruising * Glaucoma * Weight gain * Incr infection risk

Question 33

Acute management of GBS

Answer 33

* Skin care & positioning * ROM--\>Splinting to prevent contractures * Respiratory management * Progress fxnl mobility * Pt & family ed

Question 34

What does rehab consist of?

Answer 34

* Regain independence * Continue w/fxnl mobility * W/c mobility * Gait training w/BW support system or orthotics * Balance training * TherEx * Aquatic Therapy

Question 35

Is NMES effective & why?

Answer 35

No bc of demyelination