Clinical Manifestations
The classic motor presentation of GBS typically presents where first?
Progressive weakness in the lower extremities, ascending as GBS worsens
True or False: Studies estimate that developing GBS following a vaccination is up to 7x more likely than developing GBS after a flu infection
False, GBS occurrence is estimated to be 7x more likely following a flu infection, rather than a vaccination
During their stay at Rusk Rehabilitation Center, this week's patient underwent what kinds of therapy (3) to improve his neurological condition?
Physical, occupational, and speech therapy
Onset of GBS is often preceded by...
Infection. Up to 70% report a preceding infection, typically a GI or respiratory illness
The patient could not tolerate these medications (2), explaining that they caused him respiratory distress
Aspirin and ibuprofen ("allergies")
A. Areflexia
B. Autonomic Dysfunction
C. Ascending Asymmetrical Weakness
D. Facial Nerve Involvement
C. Ascending weakness in GBS is typically symmetrical
Distal and F-wave latencies are associated with what kind of diagnostic testing? How would they present in GBS?
Motor Nerve Conduction Testing. They are typically prolonged in GBS due to delayed impulse initiation/conduction.
Open answer: What are some medications used to treat epigastric burning?
Bonus: What medication was given to our patient?
1. PPI's: omeprazole, pantoprazole, esomeprazole
2. H2 antagonists: famotidine,
3. Adsorbent barrier: sucralfate
4. Antacids: bismuth-subsalicylate (pepto bismol), Calcium carbonate (TUMS) = what our patient used
Acute inflammatory demyelinating polyneuropathy
What's the patient's name, age, and hand dominance?
Mr. John Pendleton 40 yr old RHD
Open Answer: What potentially life-threatening complications need to be monitored when considering GBS?
1. ~25-30%f GBS patients develop respiratory muscle weakness severe enough to require mechanical ventilation. This occurs due to demyelination or axonal damage of the phrenic nerve and other nerves innervating the respiratory muscles
2. Immune-mediated attack on autonomic nerves ->autonomic dysfunction = also common in GBS -> dysautonomia -> severe tachycardia, bradycardia, fluctuations in BP, myocarditis, etc.
What phenomenon, which can indicate GBS, is characterized by an elevated protein level without an increase in WBC count?
Albuminocytologic Dissociation
IV immunoglobulin ->neutralizes harmful antibodies
Plasmapheresis ->removes circulating autoantibodies
GBS often follows infections. Which bacterial trigger is the most common infectious precursor?
Bonus: Where can it often be found?
Campylobacter jejuni
Poultry and animal feces
What is the patient's surgical history?
Appendectomy at 27
Which GBS variant involves ophthalmoplegia, ataxia, and areflexia, and is associated with anti-GQ1b antibodies.
Miller Fisher Syndrome
Open Answer: What differential diagnoses may also be considered when suspecting GBS?
Chronic inflammatory demyelinating polyneuropathy (CIDP) = similar but chronic
Myasthenia Gravis = fluctuating weakness but not sensory involvement
Botulism = descending paralysis and pupil involvement
Tick paralysis = rapid onset, resolves w/ tick removal
Which common anti-inflammatory treatment is NOT recommended in GBS due to their lack of proven efficacy and potential to worsen outcomes?
Corticosteroids
Each year how many patients are estimated to contract GBS worldwide?
100,000
How old is the patient's young son?
Bonus: What do the patient's mother and sister do for a living?
9 months old
Mom = physical therapist, Sister = occupational therapist
What neuronal sparing pattern is considered specific to GBS among other polyneuropathies? sorry
Sural sparing pattern = relative preservation of the sural nerve compared to other sensory nerves. Hypothesized mechanism: Sural nerve = purely sensory nerve with a relatively lower metabolic demand + more robust blood-nerve barrier compared to mixed or motor nerves = makes it less susceptible to immune-mediated damage and inflammatory processes that target peripheral nerves in GBS. Our patient did not have sural sparing...
In the absence of a definitive diagnostic test, GBS can be clinically diagnosed using this set of criteria, which includes progressive weakness and areflexia.
The Brighton Criteria, sorry
Open Answer: Name some poor prognostic factors associated with GBS
1. Older age
2. Rapid progression
3. Need for ventilation
4. Pre-existing comorbidities
Explain molecular mimicry within the context of GBS
What are the names of the patients from weeks 1-4?
Bonus: What are the diagnoses?
1. Marquis Shah - stroke patient (transcortical motor aphasia)
2. Aisha Aboud - IIH
3. Samana Hamilton - Migraine aura
4. Henry Overton - ALS