Dr Bhupendra ShahAssistant Professor

Department of internal MedicineB.P .Koirala institute of Health Sciences

History of Gullainn-Barre syndrome

Leading cause of acute flaccid paralysis in

developed countries

Ventilation in 25% cases

Death in 4-15% cases

Gullain-Barre Syndrome

Leading cause of acute flaccid paralysis in developed countries

Ventilation in 25% cases

Death in 4-15%

Delayed transmission through injured nerve

Clinical FeaturesMuscle weakness usually in the legs-Acute -Progressive-symmetric-usually peak by 2 weeks

Facial weakness

Dysautonomia

Respiratory failure

Sensory deficit:minimal

bladder /bowel:transiently involved

Why patient die in Gullain- Barre syndrome

Variants of GBS

Acute inflammatory demylinating polyneuropthy

• Acute motor axonal neuropathy

Acute motor sensory axonal neuropathy

• Miller Fisher variant

Investigation

Lumbar puncture Nerve conduction velocity

CSF Analysis -cell count :normal-Protein: elevated

Shows slowed nerve conduction velocity and prolonged distal latency

Brighton criteria1.Bilateral and flaccid weakness of the limbs

2.Decreased /absent DTR in weak limbs.

3.Monophasic ,interval between onset and nadir of weakness between 12 h and 28 days .

4.Electrophysiological study consistent with GBS.

5.CSF:cytoalbuminologic dissociation

6. Absence of alternatice diagnosis for weakness.

Diagnosis certainity

• 1+2+3+4+5+6:level 1

• 1+2+3+4/5+6:level 2

• 1+2+3+6:level 3

Treatment

• Setting : usuallly Intensive care unit

Treatment options

Immunoglobin(2g/kg:total dose) Plasmaparesis(50ml/kg/session)

• Force vital capacity<20ml/kg

• Max.inspiratory pressure:<30cm H20

• Max Inspiratory pressure:<40 cm H20

Thank you