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IN THE NAME OF GOD
GUILLAIN BARRE SYNDROM
(GBS) Z.Vaseie MD Emergency
Medicine Resident
Guillain Barre Syndrom (GBS)
Group of autoimmune conditions involving demyelination and acute axonal degeneration of peripheral nerves
Usually preceded by triggering event, e.g., infection(campylobacter jejuni),vaccination
Leading cause of acute flaccid paralysis,progressive symmetrical ascending weakness + decreased DTR+variable sensory finding +sparing anal sphincter
All ages, but rare in infancy
Guillain Barre Syndrom (GBS)
32% have all 4 extrimities affected at the time of presentation
10% have weakness that begins in the upper extrimities
Some form of cranial nerve involvement(usually 7)
Variety of GBS
1. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP)
2. Acute motor axonal neuropathy (AMAN)
3. Acute motor sensory axonal neuropathy (AMSAN)
4. Miller-Fisher syndrome (ophtalmoplegia,ataxia,areflexia)5. Acute panautonomic neuropathy
Paraclinic:
Electrophysiologic testing(EMG-NCV)
CSF:elevated protein (>45 mg/ dl) with & (white cell counts < 10/cc ) after 7 to 10 days
MRI:selective enhancement of the anterior spinal nerve roots is suggestive but not diagnostic
Nerve Biopsy:mononuclear inflammatory infiltration
Paraclinic:
Treatment:
Assessment of respiratory function
IVIG 2 gr/kg/day for 2 days
Plasma Exchange
Corticosteroids are no longer recommended
Out come:
Weakness reaches nadir at 2-4 weeks
Spontaneous resolution occurs over weeks to months.
2% _ 5% mortality