Guillian Barre'

Question 1

Definition of Guillian Barre syndrome

Answer 1

1. autoimmune disorder affecting the peripheral nervous systen
2. rapidly progressive ascending polyneuropathy
3. Triggered by acute infectious process + usually post infectious

Question 2

Pathophysiology

Answer 2

1. Infections with
   - Campylobacter jejuni
   - Cytomegalovirus
2. Trigger cell mediated autoimmune response against the myelin of the peripheral neurons of the PNS
3. Peripheral nerve damage
4. Symptoms appear 2 - 4 weeks after a diarrhoeal or URT infection

Question 3

Clinical features of PNS

Answer 3

1. Weakness and sensory loss in proximal limb muscles
2. Parasthesia in upper extremities
3. Facial muscles become weak
   - drooling or complete paralysis.
4. Autonomic features;
   - Respiratory depression
   - Arrythmia
   - Increasing heart rate

Question 4

Investigations

Answer 4

1. CSF protein is elevated but cell count and glucose was normal
2. Nerve conduction studies show elements of demyelination polyneuropathy

Question 5

Management

Answer 5

1. Ventilatory support may be required/monitor cardiac arrythmias
2. IV immunogobulin given within the first 2 weeks to reduce duration and severity of paralysis
3. LMW heparin and compression stockings to reduce risk of VTE
4. Physiotherapy

Question 6

Outcome

Answer 6

1, Most patients make a full recovery although this could take upto 18 months

2. 5% mortality
3. 30% disabled