Guillain-Barre Syndrome
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Introduction

Guillain-Barre syndrome is an acute inflammatory demyelinating polyneuropathy (AIDP). It typically comes on several weeks after viral infection, usually, GI or URTI (also sometimes flu vaccine [controversial]). HIV is also known to be a cause.
In up to 40% of cases, no precipitating factor can be found.

Epidemiology

  • 1-2 per 100 000
  • In 40% of cases, no cause is found

Clinical features

Usually signs involve a polymyopathy, that is almost always motor, and sometimes also sensory.
  • Symmetrical muscle weakness, that usually begins in the lower legs, and ascends to the upper limbs, and even the face. Usually it progresses over about 4 weeks before recovery
    • It may advance very quickly, affecting all limbs at once, and resulting in paralysis
  • Sensory signs often absent
  • Pain is common
  • Proximal muscles more affected – which helps differentiate it from other peripheral neuropathies.
    • Trunk, respiratory and cranial nerves can also be affected – again helping differentiate from other neuropathies.
    • Respiratory involvement can be life-threatening.
  • Autonomic signs – sweating, tachycardia, dysrythmias.

Pathology

The viral infection causes the production of auto-immune antibodies against peripheral nerves. Myelin is damaged, and transmission is reduced or even blocked.

Investigations

  • Lumbar punctureincreased protein in the CSF, white cell count normal.
  • Nerve conduction – slowed

Prognosis

  • 85% make complete or almost complete recovery
  • 10% unable to walk at one year
  • 10% mortality
  • The severity of the initial paralysis is NOT related to the recovery

Treatment

  • Don’t be afraid to intubate and refer to ITU at signs of respiratory problems. These occur when the respiratory muscles are affected.
  • DO NOT USE CORTICOSTEROIDS – no evidence that they help
  • IV immunoglobulin may help
  • Recovery often occurs without specific treatment

References

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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