Guillian-Barre Syndrome

Question 1

Guillian-Barres Syndrome

Answer 1

An autoimmune disorder causing acute inflammation & demyelination of the CN and peripheral nerves myelin sheaths

• Primarily inolves Schwann cells causing demyelination of peripheral nerves
• Demyelination causes impulse conduction to be slowed down, become dispersed, or blocked
• Potential axonal damage

Question 2

What are the 3 phases of GBS?

Answer 2

1. Progressive Deterioration
   Demyelination and potential axonal damage (start to progressively decline)
   Lasts approx 1-4 weeks
   Do NOT do any strength training in this phase - pointless (no evidence to show it will attenuate deterioriation)
2. Plateau
   Disease peaks and there is no further deterioration
3. Recovery
   Axonal regeneration and myelination
   Progressive recovery usually lasts 6 months - 2 years
   Complete recovery common. Most have no permanent disabilities.
   Some mild weakness may persist - common areas are the ankles - may have bilateraly drop foot
   Low mortality rate

Question 3

Characteristics of GBS

Answer 3

1. LMN syndrome
2. Motor signs always present, sensory signs may be present
3. Symptoms begin distally and moves proximally (ascending paresis) - LE affected more <- recovers in that fashion
4. Typically, symmetrical presentations

Question 4

Early S/S

Answer 4

1. Distal lower extremity paresis (weakness)
   * Most often paresis but could also by hyperalgesia, anethesia, etc
2. Distal sensory disturbances (glove & stocking distribution)
3. Muscle aches & tenderness

Question 5

S/S

(9)

Answer 5

1. ANS dysfunction
   High risk of CRPS d/t immobility
2. Atrophy (LMN)
3. Fatigue - most debilitating symptom
   Paradoxixal weakness (excessive prolonged fatigue, not restored by usual rest)
4. Hyporeflexia
5. Hypotonia
6. Pain
   Low back & leg mm pain is the most common
   So weak that they cannot move out of positions or postures that are causing them pain - more frequent position changes
7. Paresis
   Distal -> proximal
   LE > UE
   May include CN (CN VII most common)
8. Paresthesia
   Glove & stocking distribution
   Paresthesia or hypoesthesia
9. Respiratory problems
   Possible phrenic nerve involvement
   May require mechanical ventilation