Guillain-Barre syndrome
Background
- Acute polyneuropathy due to immune-mediated peripheral nerve myelin sheath destruction
- Associated with viral or febrile illness, campylobacter infection, or vaccination
- Symptoms at worst 2-4wk after onset, then plateau for 2-4wk, then remit from wks-months
Clinical Features
- Viral illness -> ascending, symmetric weakness or paralysis and loss of DTRs
- 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
- Progression over days to weeks
- Recovery beginning 2–4 wk after cessation of progression
- Relative symmetry of symptoms
- Mild sensory signs and symptoms
- CN involvement (Bell's palsy, dysphagia, dysarthria, ophthalmoplegia)
- Autonomic dysfunction
- Tachycardia, bradycardia, dysrhythmias, wide variations in BP, postural hypotension
- Urinary retention
- Constipation
- Facial flushing
- Absence of fever at onset
- Cytoalbuminologic dissociation of CSF (high protein (>45) and low WBC count (<10))
- Typical findings on electromyogram and nerve conduction studies
DDX
Treatment
- Intubation indications:
- Vital capacity <15mL/kg
- PaO2 <70 mm Hg on room air
- Bulbar dysfunction (difficulty with breathing, swallowing, or speech)
- Aspiration
- IVIG OR plasmapheresis (provide equivalent but not additive effects)
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
Source
Tintinalli