GBS Flashcards
(24 cards)
define neuropathy
pathology affecting the axon or myelin sheath of a peripheral nerve, causing loss of conduction
how is a neuropathy classified?
-rate if inset eg acute, subacute
-type of nerve fibre
-size of nerve fibre
-distribution eg symmetrical, asymmetrical
-pattern
-pathology eg axonal degeneration, demyelination
what are examples of causes of polyneuropathy?
-alcohol
-diabetes
-GBS
-tick - bone
-toxic substances
-infections
what are some motor and sensory symptoms of polyneuropathy?
sensory: loss of sensation, p+n’s, burning
motor: weakness, cramps, fasciculations
describe Guillian-Barre syndrome
-acute inflammatory demyelinating polyneuropathy - most common type
-most common cause of acute generalised paralysis
-males more common than females
-over 40s
-cause is unknown
what are different variants of GBS?
-AIDP- acute inflammatory demyelinating polyneuropathy - most common
-Miller fisher syndrome- double vision, loss of balance, deep tendon reflexes
-AMAN- acute motor axonal neuropathy - motor symptoms, no sensory
describe the aetiology of GBS
-post infection is most common eg RTI, influenza, gastroenteritis, covid-19
-autoimmune process
-demyelination
what are the clinical features of GBS?
-rapidly progressive fairly symmetrical muscle weakness
-accompanied by loss of deep tendon reflexes eg patellar, achilles
-presentation can occur a few days to a week after onset of viral symptoms
-weakness usually starts in the legs
-BP or HR instability
what is the diagnostic criteria for GBS?
1.required features: progressive weakness in moe than 1 limb, areflexia
2.supportive features:
-progression of symptoms over days to 4 weeks
relative symmetry
mild sensory symptoms or signs,
-autonomic dysfunction,
-cranial nerve involvement, especially bilateral facial nerve weakness
what are some features that make a diagnosis of GBS unlikely?
-sensory level - decrease or loss of sensation below a spinal cord root level
-marked persistent asymmetry of weakness
-severe and persistent bowel and bladder dysfunction
->50 white cells in CSF
what investigations are used to diagnose GBS?
-lumbar puncture- CSF proteins elevated
-nerve conduction studies - may be normal in early stages, then after a while you can see multifocal demyelination etc
-EMG- reduction in motor unit recruitment
what is the medical treatment options for GBS?
-intravenous immunoglobin - antibodies which can help to modulate the immune response and reduce inflammation
-plasma exchange/plasmaphoresis -plasma is removed from blood and replaced by a fluid, helps to filter out antibodies of bloodstream
what does the supportive management of GBS involve?
-management of paralysis
-NG feeding
-VENT if needed
-resp monitoring
-autonomic dysfunction - BP and arrhythmias
-pain control
-physiotherapy
how long can recovery from GBS take?
1-57 days
what are some factors associated with a poorer prognosis of GBS?
-older age
-rapid onset
-severe muscle weakness on admission
-need for vent
what does physio management of GBS involve in the early stages?
-dependent on the patient location eg ICU or ward, intubated or not
-full neuro assessment
-full resp assessment
-prevent secondary complications eg contracture
-positioning
-splinting
-PROM and AAROM
-control pain
-maintain respiratory function
what is a valid respiratory outcome measure for GBS?
EGRIS
erasmus Guillian Baare syndrome, respiratory insufficiency score
in the recovery phase of GBS, what does the physiotherapy Rx involve?
-strengthening
-mobility and gait re-education
-management of joint and soft tissue complications
-fatigue - pacing, care with exercise intensity
-CVS exercise
-start d/c planning early
-return to work
what are the effects of CVS and resistance exercise for GBS?
-its safe
-improves functional mobility
-improves cardiopulmonary function
-improves fatigue
-improves QOL
in terms of long term recovery of GBS, what are the chances of a full recovery?
-15% full recovery
-60% mild deficits
-20% severe disability
what is chronic inflammatory demyelinating polyneuropathy?
-progressive or relapsing motor and sensory dysfunction of more than 1 limb over at least 2 months
-chronic version of GBS
-similiar to GBS but slower progression, no resp involvement
what are clinical features of CIDP?
-tingling or numbness (beginning in toes and fingers)
-weakness of at least 2 limbs
-areflexia
-fatigue
what are treatments of CIDP?
-steroids eg prednisone
-IVIG
-plasmaphoresis
-immunosuppressant
