Guillain-Barre Syndrome (GBS) is an umbrella term to describe a few syndromes of immune-mediated demyelinating polyneuropathy.
This is commonly manifested by:
- Motor findings: typically weakness starts in the legs. It may ascend rather quickly and affect respiratory muscles. Facial muscles are also commonly involved. Reflexes are severely diminished to absent.
- Sensory changes: found usually in extremities. Typically mild decreases to light touch, pain, temperature. Pain in the lower extremities and back are also a common feature.
- Autonomic findings: patients may present with tachycardia, bradycardia, hypotension, urinary retention.
These symptoms may start abruptly and develop over a period of hours, days, to a couple of weeks.
A related variant: the Miller-Fischer Syndrome: This is under the same umbrella as GBS and is manifested by 1. Ophthalmoplegia, 2. Ataxia, 3. Areflexia. Patients will also usually have peripheral weakness.
Diagnosis: You will hear the term "Albuminocytologic Dissociation". This means that in the CSF there are elevated protein levels with normal WBC counts. This is a classic feature of GBS. Nerve conduction studies will also help clinch the diagnosis. MRI will often show enhancement of nerve roots.
Treatment: with plasma exchange or IVIG therapy. This is to eliminate or incapacitate auto-antibodies to schwann cells. Patients must be watched closely for possible respiratory muscle compromise. Roughly 80% will make a full recovery.
Risk Factors: Autoantibodies may form after exposure/infection:
- Campylobacter
- EBV/CMV
- HIV
- Hodgkin's Disease
- Influenza vaccine? If real, likely a tiny risk.
A few good links:
- When to suspect impending respiratory compromise in GBS.
- Evidence for treatment of GBS.
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