Weakness

Question 1

Acute post infectious polyneuropathy

Gillian Barre syndrome

Answer 1

• Auto immune, often postinfectious polyneuropathy involving mainly motor but also sensory and sometimes autonomic nerves
• Paralysis usually follows a nonspecific gastrointestinal (especially Campylobacter jejuni, or Helicobacter pylori) or respiratory infection (especially Mycoplasma pneumonia) or viral infections.

Question 2

Acute post infectious polyneuropathy

(Gillian Barre syndrome) clinical motor

Answer 2

Acute ascending flaccid paralysis:

Criteria:

• Bilateral & symmetric usually (asymmetric in 9%)
• Associated hyptonia & hyporeflexia. Progress:
• Lower Limb (inability or refusal to walk)p trunk p upper limb.
• Bulbar palsy (in 50%) p dysphonia, dysphagia & lost bulbar reflexes.
• Respiratory muscles p respiratory failure.

: Miller-Fisher syndrome consists of acute external ophthalmoplegia, ataxia, and areflexia

Question 3

Acute post infectious polyneuropathy

(Gillian Barre syndrome) sensory & automatic

Answer 3

2. Sensory Mild

• Tender calf

3. Autonomic

• Labile blood pressure & heart rate
• Urinary incontinence or retention of urine in about 20%

Question 4

Gillian barre syndrome investigations

Answer 4

: CSF: Cyto albuminous dissociation :

• High CSF protein > twice the upper limit of normal and a lack of cellular response < 10 white blood cells/mm3
• Negative bacterial culture : MRI of the spinal cord
• Thickening of the cauda equina and intrathecal nerve roots in >90% of patients
• Rule out other spinal disorders
• Motor nerve conduction velocity are greatly reduced
• Electromyography shows evidence of acute denervation of muscle.
• Serum creatine kinase (CK) level may be mildly elevated or normal

Question 5

TX of Gillian barre syndrome

Answer 5

Patients in early stages of this acute disease should be admitted to the hospital for observation because the ascending paralysis can rapidly involve respiratory muscles during the next 24 hr

i. Supportive:

• Respiratory effort monitoring (spirometry) and support
• Cardiac monitoring
• Nasogastric feeding
• Care of bladder (catheterization & neostigmine). Physiotherapy

ii. Specific

• IVIG: A commonly recommended protocol is IVIG 0.4 g/kg/day for 5 consecutive days, but some studies suggest that larger doses are more effective (1 g/kg/day for 2 consecutive days)
• Alternatives: if IVIG is ineffective
• Plasmapharesis is equally effective as IVIG.
• Combined IVIG and interferon is effective in some patients
• Steroids are not effective