Neuro - Viva - Guillian Barre Flashcards
What is GBS
Acute
Inflammatory
Demyleinating
Polyneuropathy
Thought to be autoimmune repsonse to a preceding illness
CMV, EBCV, HSC, Mycoplasma
How does GBS present
Ascending symmetrical flaccid weakness
Hypereflexia, disordered sensation, autonomic disturbance
May get lumbar back pain or intrascapular pain
Diagnosis of weakness in general
Infective:
Botulism
Diptheria
Polio
Lyme
Autoimmune - Myasthenia gravis
Organophosphate poisoning
Porphyria
B12 deficiency
Brainstem patholohy
Critical illness neuromyopathy
Transverse myelitis/cord lesion
Electrolyte abnormalities
Investigation of GBS
CT - MRI - Organic pathology and ICP
Lumbar puncture, isolated raised CSF protein
Spiro - ITU when <20ml/kg
Vent with <15ml/kg
Underlying causes:
Antibodies for C.jejuni, CMV, EBV, HSV, HIV, mycoplasma
Stool for campylobacter
Antibodies for subtypes
Other tests - B12 folate, TFT, urine porphyrins, drugs
Neurophysiology
Types and antibodies for GBS
Acute inflammatory demyelinating poly - Anti GM2 ganglioside
Miller Fishcer - Anti GQ1b ganglioside - Opthalmoplegia
Acute motor axonal neuropathy - Non inflammatory without demyelination
Acute motor and sensory axonal neuropathy - directe at sensory nerves
Criteria for admission/vent
VC<20ml/kg (15 for vent)
Low MIP
Bulbar weakness
Autonomic signs
What are the autonomic signs
Labile BP
Dysrhytmias –> sinus arrest
Delated gastric emptying
What does dysautonmia happen
Imbalance between symp and parasymp nervous systems
More common in the demyelinating form of GBS (as opposed to axonal)
Usually needs MV
May need short acting vasoactive meds
Esmolol/labetalol/GTN/norad
Management
ABCDE
ITIg - 0.4g/kg/day for 5 days - 1st line
Plas Ex - best benefit when started within 7 days of symptoms, reduces need for resp support, shorter recovery
One is not better than another
Steroids not helpful
Points to note about I&V
Do when VC < 15ml/kg
Risk of aspiration or bulbar palsy
Avoid Sux –> high K
NIV not useful and definatley not in bulbar palsy
May need early trachy
Cardiac issues
Labile BP
Arrhytmias - treat promptly
Brady on suction/rolling
General supportive issues
VTE VAP bundles, head up, suproglottic suction, sedation holds Gut care, feed, laxative (beware ileus) Physio Pressure care Analgesia --> TCAs gabapentins Pschy
Prognosis of GBS
80% good at 1 year
5% mortality
5-10% incompete recovery
10% relapse
Relapse rate
10%
Mortaltiy
5%
