Inflammation and infection Flashcards
(33 cards)
Guillian Barre syndrome
- Definition
Primary caused by an autoimmune demyelinating mechanism
Most common Guillian Barre type
Autoimmune inflammatory demyelinating polyneuropathy (AIDP)
Miller Fisher syndrome is…
Type of Guillain Barre syndrome that primary presents with
- Cranial nerve palsy (3, 4, 6)
- Ophthalmoplegia
- Areflexia
- Ataxia
- Distal paraesthesia
Associations with Guillain Barre syndrome
URTI or GI infection
GI infection
- Campylobacter jejuni
URTI
- EBV
- CMV
- HIV
Acute presentation of Guillain Barre syndrome (first 12 hours)
Symmetrical, ascending weakness and paraesthesia
Subacute presentation of Guillian Barre syndrome (1-2 weeks)
Cranial nerve palsy
Sensory deficit
Later presentations of Guillain Barre syndrome
Autonomic dysfunction
- Orthostasis
- Syncope
- Urinary retention
Respiratory muscle weakness
What investigation is used to assess respiratory compromise in GBS?
Spirometry
- Reduced FVC is major determinant for ICU/ intubation
Investigations for GBS
Bloods tests
- FBC, U+Es, lipids, LFTs, ESR
Lumbar puncture
- Normal white cells and raised proteins is indicative but if absent, does not rule out disease
Respiratory assessment
- Spirometry
- ABG
Nerve conduction
ECG
- rhythm disturbances
Management of GBS
- Respiratory support if respiratory compromise is indicated
- IV immunoglobulins
- Plasma exchange in severe disease
Prognosis of GBS:
- Most patients recover within ______
- Prognosis is worse for which patients?
Most patients have complete recovering within a year
Worse prognosis in:
- Older patients
- Longer respiratory support required
- Advanced co-morbidities
- Axonal changes in nerve studies
Differentials for GBS
- Brain
- Spinal cord
- Peripheral nerve
- NMJ
- Muscle
Brain
- Stroke
- Brainstem compression
- Encephalitis
Spinal cord
- Cord compression
- Polio
- Transverse myelitis
Peripheral nerve
- Vascuilits
- Lead poisoning
- Porphyria
NMJ
- MG
- Botulism
Muscle
- Hypokalaemia
Complications of shingles
Persistent pain= postherptic neuralgia
Eyes= Herpes zoster ophthalmicus
Ears= Herpes zoster oticus (Ramsay Hunt syndrome)
Acute retinal necrosis
The pathological agent of shingles is…
Varicella-zoster virus
Presentation of shingles
Unilateral eruption of a vesicular rash in a dermatomal pattern.
- Most commonly the lumbar and thoracic dermatomes
Severe, pain (burning)
Management of shingles
- Oral antiviral
- Acilovir
- Famciclovir
- Valaciclovir - Analgesia
- Paracetamol, oxycodone
Myasthenia gravis is associated with which tumour
Thymoma
Age distribution of MG
- Men, women
Men = 60-70
Women = 30s
The most common autoantibody associated with MG is…
Acetylcholine receptor antibodies
Less common autoantibodies associated with MG
Muscle-specific receptor tyrosine kinase (MuSK)
Low density lipoprotein receptor-related protein 4 (LRP4)
Group of muscles most commonly affected in MG are…
Proximal muscles
Muscles in head and neck
Occular symptoms of OG
Diplopia
Ptosis
Facial + neck features of MG
Facial muscle weakness
Shaky voice/ voice fatigue
Swallowing difficulty + Jaw fatigue
Slurred speech
Examination findings in MG
Fatigue after blinking repeatedly
Repeated shoulder abduction (20x) will trigger weakness
Normal muscle bulk, tone, sensation and reflexes.
