Guillain Barre Syndrome

Clinical features

Recent GI or respiratory infection

Ascending paralysis with areflexia

Sensory involvement - usually minimal but if present affects the dorsal columns (vibration, proprioception) more than the spinothalamic tracts

Subtypes can be more localised e.g. Miller Fisher Syndrome - ataxia, areflexia and opthalmoplegia and sparing of limbs

Measure FVC

Autonomic dysfunction may occur - sinus tachy common, dangerous bradyarrhythmias, postural hypotension

Investigations

CSF: raised protein and relative lack of WBCs

Identification of infection with Campylobacter (most common), Mycoplasma...

Nerve conduction studies and EMG

Demyelinating form: reduction in conduction velocity and CMAP

Axonal form: Distribution of the findings helps determine the diagnosis

Management

Specific management

Supportive management

Plasma exchange and IVIG both help reduce recovery time (either). IVIG favoured because it is easier to administer and has fewer SEs. No value in both being given routinely - give if non-ambulatory and evidence of resp decompensation

Ventilatory support - needed in 30%. Intubate if Vital Capacity <20ml/kg (~1l). NIV not useful - does not help with inability to eliminate secretions

Psychiatric support

PT/OT, nutrition, analgesia, DVT prophylaxis, pressure care

Prognosis

5% mortality from complications in hospital

7% recurrence rate

10% experience long term disability

Risk factors for poor prognosis

Older age

Rapid onset (<7 days) prior to presentation

Severe muscle weakness at presentation

Need for mechanical ventilation

Preceding Campylobacter diarrhoea (associated with axonal degeneration in addition to demyelination of peripheral nerves and spinal nerve roots)