Guillain-Barré Syndrome

a rare and serious condition of the peripheral nervous

system. It occurs when the body's immune system attacks
part of the nervous system.
 ETIOLOGY
• GBS is common to all races and ages; mild increase in
frequency in patients between ages 30-50; GBS is
less common in infants or the elderly.
• GBS has a yearly incidence of 0.6-1.9 cases/100,000
population.
• Prior infection is well established as a precipitating
event in the development of GBS. GBS preceded by
an acute illness, 1-4 weeks before, in about 75% of
cases.
 ETIOLOGY
• GBS may rarely develop within a day or
two, or after 4-6 weeks, of an acute
illness.
• Most antecedent illnesses associated
with GBS affect the upper respiratory or
GI tracts.
• Cytomegalovirus (CMV) is the most
common viral antecedent infection with
serologic evidence in up to 15% of cases
 PATHOGENESIS
• Guillain-Barré syndrome is an autoimmune
disorder that affects the nerves.
• In Guillain-Barré syndrome, the immune
response damages peripheral nerves, which
are the nerves that connect the central
nervous system (the brain and spinal cord) to
the limbs and organs.
 PATHOGENESIS
• Specifically, the immune response affects a
particular part of peripheral nerves called
axons, which are the extensions of nerve cells
(neurons) that transmit nerve impulses.
• Guillain-Barré syndrome can affect the
neurons that control muscle movement
(motor neurons);
 TYPES
Acute Inflammatory Demyelinating
Polyradiculoneuropathy (AIDP)
• In AIDP, the immune response damages
myelin, which is the covering that protects
axons and promotes the efficient transmission
of nerve impulses.
 TYPES
Acute motor axonal neuropathy (AMAN)
• The axons of motor neurons are damaged.
Acute motor-sensory axonal neuropathy
(AMSAN).
• The axons of motor and sensory neurons are
also damaged.
 TYPES
• Because of sensory nerve damage, affected
individuals can lose the ability to sense the
position of their limbs and can have abnormal
or absent reflexes (areflexia).
 TYPES
Miller Fisher Syndrome
• Involves cranial nerves, which extend from the
brain to various areas of the head and neck.
Miller Fisher syndrome is characterized by
three features: weakness or paralysis of the
muscles that move the eyes
(ophthalmoplegia), problems with balance
and coordination (ataxia), and areflexia.
 DIFFERENTIAL DIAGNOSIS
• History taking
• Standard blood tests
• Cerebrospinal fluid examination
• Electromyography – may be helpful to
establish the diagnosis.
 NEUROLOGIC EXAMINATION
• Facial weakness (cranial nerve VII) is observed
most frequently, followed by symptoms
associated with cranial nerves VI, III, XII, V, IX,
and X.
• Upper extremity, trunk, facial, and
oropharyngeal weakness is observed to a
variable extent.
• Reflexes are absent or reduced early in the
disease course.
 TREATMENT
Plasma Exchange (PE) or Plasmapheresis
• a process in which some of the patient's blood
is removed, the liquid part separated, and the
blood cells returned to the body, has been
used for severe cases.
 TREATMENT
Intravenous Immunoglobulin (IVIg)
• healthy immunoglobulin is taken from blood
donors and given to intravenously (directly
into a vein). The healthy antibodies block and
destroy the harmful antibodies that are
attacking the nerves. IVIg is given usually
every day for five days. Each infusion takes
about two hours.
 MANAGEMENT
Supportive Care: ICU monitoring & basic medical
management
Maintaining Respiratory Function:
• Monitoring for changes in vital capacity and negative
inspiratory force
• Mechanical ventilation is required if the vital capacity
falls, making spontaneous breathing impossible and
tissue oxygenation inadequate.
• Suctioning may be needed to maintain a clear airway.
 MANAGEMENT
For autonomic dysfunction:
• Assessment of BP and HR frequently.
• Sustained hypertension managed by ACE
inhibitor or beta blocking agent.
• Postural hypotension treated with fluid bolus
or positioning.
• Urinary difficulties may require intermittent
catheterization.
 MANAGEMENT
For nosocomial infections:
• Antibiotic therapy should be reserved.

For Deep Vein Thrombosis:

• Range-of-motion exercises, position
changes, anticoagulation, the use of anti-
embolism stockings or sequential
compression boots, and adequate
hydration decrease the risk of DVT.
 MANAGEMENT
Nutritional Support:
• Administer IV fluids and parenteral nutrition
as a supplement and monitor for the return of
bowel sounds.
• Nasogastric tube needed in patients who are
intubated or have significant oropharyngeal
weakness.