GBS, Guillian Barre syndrome: Difference between revisions

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=== Clinic ===
=== Clinic ===


* GBS presents with '''ascending paralysis''' and '''areflexia'''
* GBS is a series of Entities / Disease which are common in [[polyneuropathy]]
* Often secondary to an infection which leads to acute polyneuropathy.
* It presents with '''Ascending paralysis''' +  '''Areflexia'''
* GBS is an Acute / Subacute, relatively symmetric lower motor neuron paralysis
* 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
* 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 in 15%
* It is a neurologic emergency in which patients are subject to respiratory failure and cardiac arrhythmias (15%)
* [[Autonomic Nervous System|Autonomic nervous system]] problems may lead  heart rate and blood pressure.
* [[Autonomic Nervous System|Autonomic nervous system]] problems may lead  heart rate and blood pressure.
* Mortality rate: 7.5%
* Mortality rate: 7.5%
* The level of consciousness is normally unaffected in GBS, but [[Bickerstaff encephalitis entities|Bickerstaff brainstem encephalitis]] subtype may feature drowsiness, sleepiness, or coma.
* The level of consciousness is normally unaffected, but one subtype has Drowsiness/ Sleepiness / Coma. ([[Bickerstaff encephalitis entities|Bickerstaff brainstem encephalitis]])






==== Signs / Symptoms ====
=== Signs / Symptoms ===


* Numbness / Tingling / Pain
==== [[Sensory neuropathy]] ====
* Bilateral / Symmetric Weakness of the legs and arms that worsens over time.
 
* Face  / Eye /Neck Muscles may also be affected
* Numbness / Tingling  
* Swallowing difficulties
* 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%)
* Paraplegia / Paraparesis (8%)
* Bladder / Anus: (27.7% have urinary dysfunction, including urinary retention in 9.2%)
* Hypo reflexia / Areflexic


* Gait problems
==== [[Autonomic neuropathy]] ====


==== Types ====
* 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
* AIDP ([[Acute inflammatory demyelinating polyradiculoneuropathy]]) is the most common form
* [[Miller Fisher syndrome entities|Miller Fisher syndrome]], in which paralysis starts in the eyes.
* [[Miller Fisher syndrome entities|Miller Fisher syndrome]], in which paralysis starts in the eyes.
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* Extremities - Paraplegia
* Extremities - Paraplegia
* Heart - Arrythmia
* Heart - Arrythmia
 
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=== 3 Clinical Features ===
|+
 
!
* The most common initial symptom of GBS is acroparesthesia with little objective sensory loss
!JE
* Severe Radicular back pain or neuropathic pain affects most cases.
!WNE
* Weakness commonly in a symmetric “ascending pattern”.
!
* Most patients present initially with Leg and Arm weakness (32%) or selective proximal and distal leg weakness (56%) often spreading to the arm while some have onset of weakness in the arms (12%)
|-
* Besides prominent weakness, patients are Hypo reflexia / Areflexic within the first few days but this may be delayed by up to a week.
|Ascending Motor Neuropathy
* Weakness can be somewhat asymmetric, and sensory loss can also be variable, rarely presenting with a pseudo-sensory level suggesting myelopathy.
GBS + Motor neuropathy
* Facial nerve involvement occurs in up to 70% of cases
| +++
* Dysphagia in 40%
| +++
* 5% patients may develop Ophthalmoplegia, Ptosis
|
* Hearing loss, papilledema and vocal cord paralysis are less common.
|-
* Dysautonomia affects most patients and consists most commonly of sinus tachycardia, but patients may experience bradycardia, labile blood pressure with hyper- and hypotension, orthostatic hypotension, cardiac arrhythmias, neurogenic pulmonary edema, changes in sweat.
|Sensory neuropathy (Parsthesia or Hyperstasia
 
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{| class="wikitable"
{| class="wikitable"
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Latest revision as of 10:19, 21 May 2023

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.
  • 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

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 [1]

  1. ↑ Koski CL, Guillain-Barré syndrome. Neurol Clin. 1984 May;2(2):355-66
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