Neuro - GBS

Question 1

What is GBS

Answer 1

AcuteInflammatoryDemyelinating PolyneuropathyUsually as an autoimmune repsonse to a preceding illness

Question 2

What illnesses predipose

Answer 2

CampylobacterCMV, EBV,, HSVURTIMycoplasma

Question 3

How does it present

Answer 3

Ascending FlaccidSymmetrical weaknessDysreflxiea, altered sensationAutonominc disturbancePreceding illnessSevere intrascapular or back pain occassionally

Question 4

Differential diagnosis

Answer 4

Infection	Botulism	Diptheria	Poliomyelitis	Lyme

Other autoimmune MGOrganophosphate poisoningB12 def.Critical illness polyneuropathyBrainstem pathologyTransverse myelitis

Question 5

Types of GBS

Answer 5

AIDP - acute inflammatory demyelinating polyneuropathyMiller Fischer SyndromeAcute Motor Axonal NeuropathyAcute Motor and Sensory Axonal Neuropathy

Question 6

Anitbody to AIDP

Answer 6

Anti GM2 ganglioside

Question 7

Antibody to Miller Fischer

Answer 7

Anti GQ1b ganglioside

Question 8

Investigation

Answer 8

Blood work up 	Antibodies for c.jejuni, CMV, EBV, HSV, HIB, m.pneumonia	Viral hep	atypical pneumonia	C.jejuni - stool	Auto antibodies for differentiate

Neuroimaging - CT/MRILP - raised CSF proteinSpiro - VC - 20mls/kg —> ITU 15mls/ks —> TubeNeurophysiology —> NCSOther - B12, folate, TFT, urine porphyrins

Question 9

When to admit to ITU

Answer 9

Resp failure VC<20ml/lgBulbar weaknessAutonomic instability

Question 10

What is dysautonomia

Answer 10

Imbalance between symp and parasymp More common in demyelinating rather than axonal GBSLabile BP plus dysrhythmias Progress to sinus arrestGastric empty also affectedUsually present when patient needs MVNeeds invasive monitoring and infusions of short acting —> esmolol, GTN, norad

Question 11

Treatment of GBS

Answer 11

ABCDE etcTreat the GBS IVIg - 0.4g/kg/day for 5 day PLex IVig is expensive but easier to administer and fewer side effectPLex reduces need for symptom support and shortens recoveryNo evidence one is better over otherNO ROLE FOR STEROIDS

Question 12

Points to note on intubation

Answer 12

Do it if VC<15ml/kgAvoid sux - hyperkalaemiaNIV is limted and CI in bulbar palsyAutonomic dysfunction —> increased asp risk

Question 13

General supportive measures

Answer 13

VTEVAP bundles — head up, supraglottic suction, sedation hold, PPI, chlorhexGut - enteral feed, PPI, laxativesPhysioPressure and eye careAnalgesia with atypical - gabapentinPsych

Question 14

Prognosis

Answer 14

80% good out come at 1 year5% mortality5-10% incomplete recovery and prolonged ICU stay10% relapse

Question 15

Poor prognostic indicators

Answer 15

Need for MVAxonal variantElderySignificant neuro at presentation