Guillain Barré

Question 1

What is Guillain Barré?

Answer 1

Rapid onset muscle weakness caused by the immune system damaging the PNS

AKA acute inflammatory demyelinating polyneuropathy

Question 2

Key points about Guillain Barre

Answer 2

• Bilateral (usually)
• Demyelination of PNS
• Starts with tingling + weakness in hands + feet - spreads
• Develops over hrs-weeks
• 15% develop weakness of resp. muscles: need ventilation

*Very uncommon to get bladder dysfunction*

Question 3

Do patients with Guillain Barre lose control over bladder?

Answer 3

No - very rare

Question 4

Risk factors for Guillain Barre

Answer 4

Classic is a hx of GI/ resp. infection 1-3 weeks prior

Campylobacter enterocolitis = most commonly associated disease

Question 5

Pathophysiology of Guillain Barre

Answer 5

• T-cells produce cytokines that activate B-cells which make antibodies against myelin

Connection between neurones breaks down = sensory, motor and cognitive dysfunction

75% of patients have a preceding infection - molecular mimicry occurs where body attacks neurones thinking they are the bacteria

• Deymelination occurs in patches (segmental demyelination)

Question 6

Which nerves are demyelinated as a result of Guillain Barre?

Answer 6

PNS nerves and CN III-XII

Question 7

Line to describe Guillain Barre

Answer 7

Post infectious autoimmune polyneuropathy causing patchy demyelination in the PNS and cranial nerves

Question 8

What are the initial symptoms of Guillain Barre?

Answer 8

Pins + needles, pain, weakness in extremities

‘Started wiht a tingling sensation in legs and now cannot lift them’

Double vision

Question 9

Classical presentation of Guillain Barre

Answer 9

Bilateral flaccid paralysis spreading from the legs to the arms in a stocking-glove distribution

Weakness, tingling, double vision over a few days

Weakness in hands

Symmetrical/ bilateral

Patients go from being active and independent to bedbound within days-weeks

Question 10

What does the presentation of Guillain Barre depend on?

Answer 10

Nerves affected

Motor: muscle weakness, absent reflexes (ankle reflex lost 1st - LMN sign)

Cranial nerves: double vision, facial diplegia

Phrenic nerve: respiratory failure as diaphragm paralysed

Autonomic nerves: bowel and bladder symptoms, constipation, incontinence

Question 11

What would happen to reflexes in Guillain Barre?

Answer 11

They would reduce because it affects PNS and is therefore a LMN lesion

Question 12

Autonomic symptoms associated with Guillain Barre

Answer 12

Arrhythmias, HTN or low BP

Intestinal dysfunction

Reduced sweating

Reduced heat tolerance

Question 13

Investigations for Guillain Barre

Answer 13

Lumbar puncture: Acellular CSF + high protein (albumin) *WBC should be normal, anything >50/uL means GBS unlikely*

Nerve cnduction: widespread slowed conduction (can be normal early on)

Resp. function tests

• Antibody screen: antibodies against peripheral nerves

ECG: lack of HR variation related to breathing - breathing in should cause HR to increase, breathing out should cause it to decrease

Question 14

Examination findings in Guillain Barre

Answer 14

• Hypotonia
• Hyporeflexia
• Facial weakness
• Fluctuations in HR and BP
• Respiratory muscle weakness/ paralysis

Question 15

Management of Guillain Barre

Answer 15

Can be life threatening: admit and monitor closely

Supportive: monitor breathing, HR, BP

- IV immunoglobulin = 1st line

• Plasma exchange to remove the antibodies damaging myelin
• DVT prophylaxis
• Pain relief for neuropathic pain

**Do not give corticosteroids - may delay recovery**

Question 16

What do we not give patients with Guillain Barre that would seem to make sense?

Answer 16

Corticosteroids - makes things worse/ slows recovery

Question 17

Prognosis of Guillain Barre

Answer 17

Most patients fully recovery over several months

3-7% die from complications e.g. resp. paralysis, pulmonary infection, PE, cardiac dysfunction