Guillain-Barre syndrome: Difference between revisions

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*Relative symmetry of symptoms
*Relative symmetry of symptoms
*Mild sensory signs and symptoms
*Mild sensory signs and symptoms
*CN involvement ([[Bell's Palsy]], dysphagia, dysarthria, ophthalmoplegia)
*CN involvement ([[Bell's Palsy]], [[dysphagia]], [[dysarthria]], [[ophthalmoplegia]])
*Autonomic dysfunction
*Autonomic dysfunction
**Tachycardia, bradycardia, dysrhythmias, wide variations in BP, postural hypotension
**[[Tachycardia]], [[bradycardia]], [[dysrhythmias]], wide variations in BP, postural [[hypotension]]
**[[Urinary Retention]]
**[[Urinary Retention]]
**[[Constipation]]
**[[Constipation]]
**Facial flushing
**Facial flushing
*Absence of fever at onset
*Absence of [[fever]] at onset
*Albumin-cytological dissociation of [[CSF]] (high protein (>45) and low WBC count (<10))<ref name="Rosen">Bunney EB, Gallagher EJ: Peripheral Nerve Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 105:p 1400-1401.</ref>
*Albumin-cytological dissociation of [[CSF]] (high protein (>45) and low WBC count (<10))<ref name="Rosen">Bunney EB, Gallagher EJ: Peripheral Nerve Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 105:p 1400-1401.</ref>
*Typical findings on electromyogram and nerve conduction studies
*Typical findings on electromyogram and nerve conduction studies

Revision as of 02:57, 24 February 2015

Background

Clinical Features

  • Viral illness -> ascending, symmetric weakness or paralysis and loss of DTRs
  • Little or no sensory involvement
  • May progress to diaphragm resulting in need for mechanical ventilation (33% of pts)
  • Autonomic dysfunction occurs in 50% of pts

Miller-Fisher Syndrome

  • Associated w/ campylobacter infection
  • More likely to be preceded by diarrhea than viral prodrome
  • Consists of ophthalmoplegia and ataxia
  • Weakness is less severe but DESCENDING; disease course milder than classic GBS

Diagnosis

Required

  • Progressive weakness of more than one limb
  • Areflexia

Suggestive

Differential Diagnosis

Weakness

Treatment

  • IVIG OR plasmapheresis (provide equivalent but not additive effects)

Intubation indications

  • Vital capacity <15mL/kg
  • Negative Inspiratory Force < 30 cm H2O
  • PaO2 <70 mm Hg on room air
  • Bulbar dysfunction (difficulty with breathing, swallowing, or speech)
  • Aspiration

Disposition

Indications for admission to ICU

  • Autonomic dysfunction
  • Bulbar dysfunction
  • Initial vital capacity <20 mL/kg
  • Initial negative inspiratory force <–30 cm of water
  • Decrease of >30% of vital capacity or negative inspiratory force
  • Inability to ambulate
  • Treatment with plasmapheresis
  • Anticipated clinical course requiring mechanical ventilation

See Also

Source

  1. 1.0 1.1 Bunney EB, Gallagher EJ: Peripheral Nerve Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 105:p 1400-1401.