Guillain-Barre Syndrome

Overview

100

GBS is an acute immune-mediated ____ that typically presents with flaccid paralysis and sensory involvement 

Polyneuropathy 

200

What percent of patients with GBS regain the ability to walk unaided 6 months after symptom onset 

Approximately 80%

Up to 20% of patients remain severely disabled and approximately 5% of patients die despite medical treatment 

300

Pain in these areas are often an early symptom of GBS and affect approximately 2/3 of patients 

Back and Limb Pain 

Involves nociceptive and neuropathic pain 

400

65% of patients with GBS have this before the onset of symptoms 

Upper respiratory or gastrointestinal infection 

Symptoms of GBS peak at 2-4 weeks

500

This attacks antigens in the myelin sheath, other Schwann-cell antigens, and axon membranes 

Autoantibodies 

Clinical Manifestations/Presentation

100

Typically limb involvement in Guillain-barre typically starts here 

Lower limbs and then ascends, typically bilaterally 

200

Paresthesia in GBS typically has this characteristic distribution 

Stocking-Glove distribution 

300

This strength/lack of strength reflex typically begins in the lower limbs with GBS 

Hyporeflexia or Areflexia 

400

Cardiac arrhythmias, blood pressure fluctuations, urinary and/or intestinal dysfunction can occur in GBS due to dysfunction of this part of the nervous system 

Autonomic Dysfunction 

500

GBS can impact CN 3-12, what is the most common CN symptom associated with GBS

Facial Diplegia (Bilateral facial palsy) 

Due to bilateral facial nerve involvement 

Diagnostics

100

Main treatment options for GBS include 

Intravenous Immunoglobulins 

or 

Plasmapheresis 

We also want to monitor respiratory muscle function and autonomic function 

200

The most common disease associated with GBS is 

Campylobacter jejuni - causes inflammatory gastroenteritis 

Transmission through fecal oral or through ingestion of undercooked, contaminated meat or unpasteurized milk 

Gram - : Lipopolysaccharide in outer membrane is similar to gangliosides (A component of peripheral nerves) 

Others: CMV, HIV, 

300

Autoantibodies from against peripheral Schwann cells, unknown antigens and this other molecule that are particularly abundant in the CNS and PNS, where they play an important role in the development and regeneration of neuronal cells 

Gangliosides 

Particularly include anti-GM1, anti-GD1A, anti-GT1A, and GQ1B. Different antibodies are associated with different variants of GBS 

Although these laboratory studies usually require some time to obtain results and therefore may not be as helpful in decision making at the time of patient admission 

400

CSF analysis shows this type of dissociation 

Albuminocytologic (High protein, Normal WBC) 

CSF protein count may be normal if done within 1 week of symptom onset 

Rise in protein is thought to be due to disruption of the blood-csf barrier due to nerve inflammation 

500

Nerve conduction studies in GBS typically show 

Decreased Nerve Conduction Velocity 

(Signs of demyelination) 

Prolonged H-reflexes and/or F wave latencies are also common early electrodiagnostic findings in GBS