PNS Guidelines GBS Flashcards
(40 cards)
What is Guillain-Barré Syndrome (GBS)?
Acute immune-mediated polyradiculoneuropathy
GBS is characterized by rapid onset of muscle weakness and is considered an emergency due to potential respiratory failure.
What is the global incidence of GBS?
1–2 per 100,000 person-years
This statistic reflects the estimated frequency of GBS in the general population.
What is the peak age for GBS incidence?
50–70 years
Males are affected more frequently than females, with a ratio of 1.5:1.
What are the typical variants of GBS?
Motor-sensory and pure motor
Motor-sensory is the most common in Europe and North America, while pure motor is more prevalent in Asia.
List some atypical variants of GBS.
- Pharyngeal-cervical-brachial
- Bilateral facial weakness with paresthesias
- Paraparetic
- Pure sensory
- Miller Fisher syndrome
- Bickerstaff brainstem encephalitis
These variants can present with different symptoms and may require specific diagnostic considerations.
What are the required diagnostic features for GBS?
- Progressive limb weakness
- Hypo/areflexia in affected limbs
- Progression ≤4 weeks
The nadir of symptoms is usually reached by 2 weeks.
What supportive features may indicate GBS?
- Symmetry
- Mild sensory symptoms
- Cranial nerve involvement
- Autonomic dysfunction
- Recent infection (≤6 weeks)
These features can help strengthen the diagnosis of GBS.
What laboratory finding is characteristic of GBS in CSF analysis?
Albuminocytologic dissociation (↑ protein, WBC <50/μL)
This finding is a hallmark of GBS but may not be evident in the early stages.
What are some red flags that may suggest alternative diagnoses instead of GBS?
- Asymmetric weakness
- Sensory level
- Hyperreflexia/extensor plantars
- Abdominal pain/vomiting
- Nystagmus
- Alterations to consciousness
- Fever at onset
Recognizing these signs is crucial for differential diagnosis.
What is the role of electrodiagnostics in GBS?
- Demyelinating/axonal patterns may be observed
- Absent H-reflexes
- Sensory conduction abnormalities
Initial findings can be normal, and specific patterns help to confirm the diagnosis.
What immunotherapy treatments are recommended for GBS?
- Plasma Exchange (PE)
- Intravenous Immunoglobulin (IVIg)
Both treatments are effective but have specific protocols and contraindications.
What is the recommended plasma exchange protocol for non-ambulatory patients?
4–5 exchanges (12–15 L total) over 1–2 weeks within 4 weeks of onset
This is a strong recommendation for patients with GBS DS grade 3 or more.
What should be avoided in the treatment of GBS?
- Oral corticosteroids
- Intravenous methylprednisolone
- Eculizumab, alemtuzumab, cyclophosphamide
These treatments have been shown to be ineffective or harmful in GBS management.
What factors predict a poor outcome in GBS?
- Older age
- Preceding diarrhea
- Severe weakness at onset
- Low CMAP amplitudes (<20% LLN)
These factors can help clinicians assess prognosis.
What is the purpose of mEGOS in GBS?
Predicts inability to walk at 4/26 weeks
This scoring system helps in assessing the severity and potential recovery of patients.
What does mEGRIS predict in GBS patients?
Need for mechanical ventilation
This tool assists in identifying high-risk patients who may require intensive care.
Fill in the blank: The presence of _______ is a hallmark feature of Miller Fisher syndrome.
Anti-GQ1b antibodies
These antibodies are strongly associated with MFS and help in confirming the diagnosis.
What is the initial treatment for pain in GBS?
- Gabapentin
- Carbamazepine
- Tricyclic antidepressants
These medications can help manage neuropathic pain in GBS patients.
What supportive care strategies should be employed in GBS patients?
- ICU monitoring
- Pain management
- Fatigue management
Supportive care is critical in managing complications and improving quality of life.
True or False: Corticosteroids are recommended for the treatment of GBS.
False
Corticosteroids have been shown to be ineffective and may worsen outcomes in GBS.
What is A-CIDP and when should it be suspected?
A-CIDP (Acute Chronic Inflammatory Demyelinating Polyneuropathy) should be suspected if progression >8 weeks or ≥3 treatment-related fluctuations
Recognizing A-CIDP is important for appropriate management.
What is a key takeaway regarding GBS diagnosis?
Diagnose clinically + CSF/electrodiagnostics; reserve antibodies/MRI for atypical cases
This approach ensures timely and accurate diagnosis.
What are the diagnostic criteria for motor-sensory or motor GBS?
Features required: Progressive weakness of arms and legs; Tendon reflexes absent or decreased in affected limbs; Progressive worsening ≤ 4 weeks.
None
What features support the diagnosis of GBS?
Relative symmetry; Relatively mild/absent sensory symptoms and signs; Cranial nerve involvement; Autonomic dysfunction; Respiratory insufficiency; Pain; Recent history of infection; CSF: protein increased; white cells: usually < 5x10€ /1; Electrodiagnosis: nerve conduction studies consistent with polyneuropathy.
None
