Guillian Barre

Question 1

What is GBS?

Answer 1

It is a peripheral neuropathy. It is an acute paralytic polyneuropathy affecting the PNS.

Question 2

Pathophysiology of GBS?

Answer 2

Triggered by an infection (e.g. gastroenteritis; EBV, campylobacter jejuni).
Molecular mimicry: B cells of the immune system create ABs against antigens on pathogen. These also match proteins on myelin sheath of motor nerve cells.
The ABs damage the nerve cells

Question 3

Symptoms of GBS

Answer 3

Symmetrical ascending weakness starting at the feet
Heavy legs
Reduced reflexes
Sensory symptoms: loss of sensation, neuropathic pain
Can progress to cranial nerves and cause facial nerve weakness

Question 4

Clinical course of GBS?

Answer 4

Preceeding infection.
4 weeks later symptoms start
Symptoms peak within 2-4 weeks
Recovery period over months to years

Question 5

How is GBS diagnosed?

Answer 5

Clinically
Nerve conduction studies
LP (raised protein in CSF with normal glucose)

Question 6

Management of GBS?

Answer 6

IV immunoglobulins (replace/neutralise dodgey ABs)
plasma exchange (alternative to IV IG)
VTE prophylaxis (PE is leading cause of death)

Question 7

Prognosis?

Answer 7

80% recover
15% left with neuro disability
5% die–> severe cases have resp failure