GBS, Guillian Barre syndrome

Clinic

• GBS is a series of Entities / Disease which are common in polyneuropathy
• It presents with Ascending paralysis + Areflexia
• Often secondary to an infection which leads to acute polyneuropathy.
  • Motor neuropathy: PLV, JE, TBE, WNE
  • Sensory neuropathy
  • Autonomic neuropathy
• GBS is an Acute / Subacute, Relatively symmetric lower motor neuron paralysis
• Up to 85% of patients obtain a full or functional recovery
• It is a neurologic emergency in which patients are subject to respiratory failure and cardiac arrhythmias (15%)
• Autonomic nervous system problems may lead heart rate and blood pressure.
• Mortality rate: 7.5%
• The level of consciousness is normally unaffected, but one subtype has Drowsiness/ Sleepiness / Coma. (Bickerstaff brainstem encephalitis)

Signs / Symptoms

Sensory neuropathy

• Numbness / Tingling
• The most common initial symptom of GBS is acroparesthesia with little objective sensory loss
• Severe Radicular back pain / Neuropathic pain

Motor neuropathy

• Bilateral / Symmetric / Progressive Weakness of Legs / Arms
• Ascending Weakness
• Gait problems
• Ophthalmoplegia / Ptosis (5%)
• Leg /Arm weakness (32%)
• Selective Proximal / Distal leg weakness (56%) often spreading to the arm
• Onset of arms weakness (12%)
• Face / Eye / Neck Muscles may also be affected (70%)
• Paraplegia / Paraparesis (8%)
• Hypo reflexia / Areflexic

Autonomic neuropathy

• Bladder / Anus: (27.7% have urinary dysfunction esp urinary retention 9.2%)
• Dysphagia (40%)
• Hearing loss, papilledema and vocal cord paralysis are less common.
• Sinus tachycardia, but patients may experience bradycardia,
• Labile blood pressure with hyper- and hypotension, orthostatic hypotension,
• Cardiac arrhythmias
• Neurogenic pulmonary edema
• Changes in sweat

Types

• AIDP (Acute inflammatory demyelinating polyradiculoneuropathy) is the most common form
• Miller Fisher syndrome, in which paralysis starts in the eyes.
• Acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN) are less common.
• Bickerstaff brainstem encephalitis
• Acute motor sensory axonal neuropathy
• Acute panautonomic neuropathy

	GBS	Hypo Reflexia	Diplopia/ Bilateral ophthalmoplegia
AIDP		+++
MFS			+++
AMAN
Bickerstaff brainstem encephalitis
Acute motor sensory axonal neuropathy
Acute panautonomic neuropathy
		CMV, RBS	SHBV

2 Entities:

• Paresthesia
• Face - Palsy
• Esophagus  - Dysphagia
• Extremities - Paralysis
• Extremities - Paraplegia
• Heart - Arrythmia

	JE	WNE
Ascending Motor Neuropathy GBS + Motor neuropathy	+++	+++
Sensory neuropathy (Parsthesia or Hyperstasia

Entities Miasms	SHBV	VZV	CMV	MMP	EBV	RBS	CXA, B, ECHO	HBV
Dysestheia	+++
Radiculopathy		+++
Loss of deep tendone reflex			+++
Face, Palsy		+++		+++	+++
Dysphagia			+++		+++
Ophtalmoplegia		+++
Choking sensation						+++
Papiloedema							+++	+++
Deafness		+++	+++	+++
Orthostatic Hypotention			+++
Sympathetic hyperactivity						+++

Note that Miller Fisher syndrome miasm is SHBV due to theses entities: Diplopia + Incoordination + GBS