GBS, Guillian Barre syndrome

Clinic

• GBS presents with ascending paralysis and 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 in 15%
• Autonomic nervous system problems may lead heart rate and blood pressure.
• Mortality rate: 7.5%
• The level of consciousness is normally unaffected in GBS, but Bickerstaff brainstem encephalitis subtype may feature drowsiness, sleepiness, or coma.

Signs / Symptoms

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

• Gait problems

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

3 Clinical Features

• The most common initial symptom of GBS is acroparesthesia with little objective sensory loss
• Severe Radicular back pain or neuropathic pain affects most cases.
• 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.
• Weakness can be somewhat asymmetric, and sensory loss can also be variable, rarely presenting with a pseudo-sensory level suggesting myelopathy.
• 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.

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