StartFragment
- Guillain Barre: acute idiopathic inflammatory
demyelinating polyneuropathy
- sensory disturbance (tingling)
- progressive muscle weakness and
areflexia (rubbery legs)
- associated with spontaneous
remission
- annual incidence of 0.6 -2.4
cases per 100,000 population
- occurs at all ages and both
sexes
- most common cause of acute
flaccid paralysis in healthy people
- a heterogeneous syndrome with
several variant forms
- Associated conditions
Antecedent respiratory tract or
gastrointestinal infection
EBV, CMV, HSV, Lyme, H. flu,
campylobacter jejuni
- Post vaccine
Swine influenza vaccine 1976
13
days post Rx
- Clinical features
Sx develop 1-3 weeks post infection
Fine paresthesias of toes and
fingertips
Symmetrical lower extremity weakness
(progressive)
Weakness ascends to arms, cranial
nerves (7)
Facial
diparesis
Respiratory muscles may be involved
Sciatic pain may be present
30% require mechanical ventilation
mild
form: upper ext weakness,
areflexive, gait difficulty
mod form: unable to walk alone
severe form: ascending paralysis, may require vent
- Physical exam
Symmetrical weakness with diminished
or absent reflexes
Orthostatic hypotension
Paralytic ileus
Bladder dysfunction
Abnormal sweating
- Diagnosis
NCS are slowed
Partial motor conduction block
Helps to prognosticate
CSF shows increased protein and normal
wbc = albuminocytologic dissociation
Antibodies may be present dependent on
variant
- Management
20/30/40 rule
Vital capacity of <20 ml/kg,
inspiratory pressure of <30 or expiratory pressure <40
Need to intubate
Monitor for s sx autonomic dysfunction
- Treatment
Plasma exchange
for
pts who are unable to ambulate, poor vital capacities, require mechanical
ventilation
4-6
Rx over 10 days
Removes
circulating Abs and complement
IV immune globulin x 5 d
mechanism
of action unknown
in
animals, neutralizes neuromuscular blocking antibodies
prevents
complement activation
interferes
with cytokine production
Corticosteroids no benefit
Interferon (beta) questionable
80% completely recover
EndFragment
