GBS

• Guillian Barre syndrome is an acute paralytic polyneuropathy

  Acute inflammatory demyelinating polyneuropathy is the most common form of GBS

  It is usually triggered by an infection - associated with Campylobacter Jejuni, cytomegalovirus and Epstein-Barr virus
• Guilllian Barre Syndrome presents as:

  • Acute ascending weakness
  • Bilateral
  • Sensory symptoms - painful pins and needles
  • Paralysis can ascend to the respiratory muscles and cause respiratory failure
• Examination of Guillian Barre syndrome:

  • Full neurological exam - absent deep tendon reflexes and changes in sensation
  • Nerve conduction test will show slow velocity
  • Lumbar puncture - raised protein and normal white cell count
  • Spirometry to monitor for respiratory muscle involvement - forced vital capacity
• Treatment of Guillian Barre Syndrome:

  • Plasma exchange - to remove antibodies
  • IV immunoglobulins (first line)
  • Supportive care - mechanical ventilation
  • VTE prophylaxis - PE is leading cause of death in GBS
• Molecular mimicry occurs in Guillian Barre syndrome. B cells produce antibodies against the invading pathogen but these antibodies also match proteins on the peripheral nerves. They can attack the myelin sheath or the axon itself
• The characteristic findings on a LP during acute GBS:

  • Albuminocytologic dissociation =
  • Elevation in protein
  • Normal WCC
• Corticosteroids, often used for other classical autoimmune conditions, have shown no clinical benefit in GBS.
• The diagnosis of GBS is made clinically using the Brighton criteria