Neuro

Question 1

Usual pattern of GBS in terms of paralysis

Answer 1

Ascending Paralysis

Question 2

In GBS, ascending paralysis may be noticed first as ____________.

Answer 2

Rubbery Legs

Question 3

Signs of Early Stages of GBS (occurred in 50% of patients)

Answer 3

Pain in the neck, shoulder, back, or diffusely over the spine

Question 4

What are the criteria for patient with GBS to hook with mechanical ventilation?

Answer 4

a rapid tempo progression; presence of facial and/or bulbar weakness during first week of symptoms

Question 5

In patient with GBS, DTR usually attenuate or disappear ________.

Answer 5

within the first few days of onset

Question 6

When is further progression of GBS unlikely?

Answer 6

Once clinical worsening stops and patient reaches PLATEAU (almost always within 4 weeks of onset)

Question 7

Autonomic involvement is common in GBS. What are the usual manifestations?

Answer 7

1. loss of vasomotor control with wide fluctuations in blood pressure
2. postural hypotension
3. cardiac dysrhythmias

Question 8

ECG findings in GBS with autonomic involvement.

Answer 8

T wave inversion, ST segment depression, QT prolongation, and Resting Tachycardia.

Question 9

Term described the occurrence of cardiac abnormalities due to neurological events such as stroke, seizures, etc. These events lead to dysfunction of the autonomic nervous system (ANS) and ultimately cause injury to the myocardium.

Answer 9

Neurogenic Stunned Myocardium

Question 10

Most common variant of GBS

Answer 10

Acute Inflammatory Demyelinating Polyneuropathy (AIDP)

Question 11

Two axonal variants of GBS

Answer 11

Acute Motor Axonal Neuropathy (AMAN);

Acute Motor-Sensory Axonal Neuropathy (AMSAN)

Question 12

A range of limited or regional GBS, presents as rapidly evolving ATAXIA and AREFLEXIA of limbs without weakness , and OPTHALMOPLEGIA (often with pupillary paralysis)

Answer 12

Miller Fisher Syndrome

Question 13

What acute systemic infections do GBS follow after 1-3 weeks of infectious process?

Answer 13

Respiratory or Gastrointestinal Infections

Question 14

Name the microorganisms that are associated with GBS

Answer 14

Campylobacter jejuni;
Human Herpes Virus;
CMV or Epstein Barr Virus;
Other (HIV, Hep E, Zika Virus & Mycoplasma Pneumoniae)

Question 15

Pathologic finding seen in AIDP (GBS subtype)

Answer 15

Schwan Cell Surface Damage (Complement Deposition); Demyelinating

Question 16

Pathologic finding seen in AMAN/AMSAN (GBS subtype)

Answer 16

First attack or damage on Motor Nodes of Ranvier ; Axonal injury

Question 17

In AIDP (subtype of GBS) elevated levels of cytokines and cytokine receptors are present in serum

Answer 17

IL-2; Soluble IL-2 receptor

Question 18

In AIDP (subtype of GBS) elevated levels of cytokines and cytokine receptors are present in CSF

Answer 18

IL-6; TNF-a; Interferon-y(gamma)

Question 19

This is a mechanism used to describe that all GBS results from immune response to nonself antigens (infectious agents, vaccines) that misdirect to host nerve tissue through resemblance-of-epitope

Answer 19

Molecular Mimicry Mechanism

Question 20

most commonly presented antiganglioside antibodies found in GBS, and in those cases preceded by Campylobacter jejuni infection

Answer 20

Anti-GM1 antibodies

Question 21

Most Common Ig isotype found in GBS

Answer 21

Ig G (polyclonal)

Question 22

Antibodies that are commonly found in >90% of patients with Miller Fisher Syndrome. These antibodies could not be found in other forms of GBS unless there is Extraocular Motor Nerve Involvement

Answer 22

Anti-GQ1B antibodies

Question 23

Anti-GQ1B antibodies are commonly found in patients with MFS, but these could be found in other forms of GBS when this nerve is involved.

Answer 23

Extraocular Motor Nerve (CN III, CN IV, CN VI)

rationale: EOM nerves are enriched in GQ1b gangliosides in comparison to limb nerves

Question 24

In demyelinating forms of GBS, what is the basis for FLACCID PARALYSIS and SENSORY DISTURBANCE?

Answer 24

Conduction Block

Question 25

CSF findings in GBS

Answer 25

Elevated CSF protein level (1-10g/L [100-1000mg/dl]) without pleocytosis;

often normal when symptoms presented for <48hrs, usually by the end of 1st week CSF protein is elevated

Question 26

Criteria used to diagnose Guillain-Barre Syndrome (GBS) and Miller-Fisher Syndrome (MFS)

Answer 26

Brighton Criteria

Question 27

Treatment of choice for GBS

Answer 27

High-dose IVIG or Plasmapheresis

Note: Combination of the two is not significantly better than either alone

Question 28

Preferable treatment for AMAN and MFS variants of GBS

Answer 28

IVIG

Question 29

IVIG administration in GBS is given as _____________.

Answer 29

5 daily infusions for a total dose of 2g/kg body weight

Question 30

Plasmapheresis administration in GBS usually consists _______________.

Answer 30

~40-50mL/kg PE 4-5 times over 7-10 days

Note:

• reduces need for mechanical ventilation by ~50%
• increases the likelihood of full recovery at 1 year

Question 31

Are glucocorticoids effective in treating patient with GBS? Yes or No.

Answer 31

NO