Guillain-Barre Syndrome

Etiology

Following a viral or bacterial infections, especially cytomegalovirus (CMV) and Campylobacter Jejuni (diarrhea)

Also develop after certain immunizations

Pathophysiology

Pain and numbness

Muscle paralysis then spreads upward and affects the lungs by insufficient negative pressure generated and inability to exert a cough

Symmetric muscle weakness in the distal extremities after 1-4 weeks of febrile illness

Clinical Signs & Symptoms

History of Recent Febrile Illness

Rapidly progressing ascending symmetrical muscle weakness/paralysis

Decreased or absent deep tendon reflexes

Dysphagia and Dyspnea

Dysautonomia (cardiac arrhythmias)

Diagnostic Tests

Cerebrospinal Fluid (High protein, low WBC; also called albuminocytologic dissociation of the spinal fluid)

EMG and NCS with a slowing or blockage of nerve conduction

Antibody tests showing increased antiganglioside antibodies

Elevated AST and ALT (liver enzymes)

Decreased VC, MIP/NIF, MEP for spirometry

Differential Diagnosis

Acute Myelopathy

Tick Paralysis

Bilateral Stroke

Spinal Cord Compression

Respiratory Management

VC, NIF monitoring Q8H

Oxygen support to keep SpO2 > 90%

Intubation if: VC <1L or <15ml/kg, MIP/NIF <-25 MEP <40, Inability to cough, swallow and protect the airway, ABG evidence of respiratory failure