IN THE NAME OF GOD

GUILLAIN BARRE SYNDROM

(GBS) Z.Vaseie MD Emergency

Medicine Resident

Guillain Barre Syndrom (GBS)

Group of autoimmune conditions involving demyelination and acute axonal degeneration of peripheral nerves

Usually preceded by triggering event, e.g., infection(campylobacter jejuni),vaccination

Leading cause of acute flaccid paralysis,progressive symmetrical ascending weakness + decreased DTR+variable sensory finding +sparing anal sphincter

All ages, but rare in infancy

Guillain Barre Syndrom (GBS)

32% have all 4 extrimities affected at the time of presentation

10% have weakness that begins in the upper extrimities

Some form of cranial nerve involvement(usually 7)

Variety of GBS

1. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP)

2. Acute motor axonal neuropathy (AMAN)

3. Acute motor sensory axonal neuropathy (AMSAN)

4. Miller-Fisher syndrome (ophtalmoplegia,ataxia,areflexia)5. Acute panautonomic neuropathy

Paraclinic:

Electrophysiologic testing(EMG-NCV)

CSF:elevated protein (>45 mg/ dl) with & (white cell counts < 10/cc ) after 7 to 10 days

MRI:selective enhancement of the anterior spinal nerve roots is suggestive but not diagnostic

Nerve Biopsy:mononuclear inflammatory infiltration

Paraclinic:

Treatment:

Assessment of respiratory function

IVIG 2 gr/kg/day for 2 days

Plasma Exchange

Corticosteroids are no longer recommended

Out come:

Weakness reaches nadir at 2-4 weeks

Spontaneous resolution occurs over weeks to months.

2% _ 5% mortality