Guillain-Barre Syndrome - Summary Acute AIDP that presents with rapidly progressive flaccid weakness Epidemiology: • 1-2 cases/100,000 per year • Slightly greater in males than females Guillain-Barre Pathophysiology: • Immune response preceding infection - Campylobacter jejuni - HIV, CMV, EBV - Influenza like illnesses, COVID 19 - Zika virus - Vaccination (flu, meningococcal, H1N1) Clinical Manifestations: • Fairly symmetric muscle weakness • Absent or depressed DTR’s • Onset: Few days to a week • Weakness: mild difficulty with walking to nearly complete paralysis of all extremity, facial, respiratory and bulbar muscles Guillain-Barre Clinical Features: • Weakness: Starts in legs and ascends usually. Can begin in arms or face (10% of patients) • Respiratory Muscle Weakness: May require ventilator support (10-30%) • Facial Nerve Palsies / Oropharyngeal Weakness • Oculomotor Weakness • Decreased / Absent Reflexes: Arms or legs • Paresthesias: Hands or feet • Pain: Due to nerve root inflammation. Back or extremities • Dysautonomia: Life threatening labile BP and arrythmias • Other: Diarrhea/constipation, hyponatremia, bradycardia, urinary retention, tachycardia, reversible cardiomyopathy, Horner syndrome, Sudden death Miller Fisher Syndrome: • Opthaloplegia • Ataxia • Areflexia Guillain-Barre Diagnosis: • CSF: - CSF PROTEIN - NORMAL CSF WBC (Albuminocytologic dissociation) • Electrodiagnostic studies - EMG, NCV can classify the main variants: (1) acute polyneuropathy with demyelination features (2) axonal form • MRI - Thickening and enhancement of intrathecal spinal nerve roots and cauda equina • GQ1b IgG Antibody associated with Miller Fisher Variant. Treatment: • Plasmapheresis + IVIG • Mechanical ventilation • Steroids contraindicated- worse outcome #GuillainBarre #Guillain #Barre #Syndrome #diagnosis #management #treatment #neurology
