Guillain-Barre syndrome: Difference between revisions
m (Rossdonaldson1 moved page Guillain-Barre Syndrome to Guillain-Barre syndrome) |
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*Associated with viral or febrile illness, campylobacter infection, or vaccination | *Associated with viral or febrile illness, campylobacter infection, or vaccination | ||
*Symptoms at worst 2-4wk after onset, then plateau for 2-4wk, then remit from wks-months | *Symptoms at worst 2-4wk after onset, then plateau for 2-4wk, then remit from wks-months | ||
*Associated with Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus, and Mycoplasma pneumoniae | *Associated with [[Campylobacter jejuni]], [[cytomegalovirus]], [[Epstein-Barr virus]], and [[Mycoplasma pneumoniae]] | ||
==Clinical Features== | ==Clinical Features== | ||
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*Miller-Fisher Syndrome | *Miller-Fisher Syndrome | ||
**Associated w/ campylobacter infection | **Associated w/ [[campylobacter]] infection | ||
**More likely to be preceded by diarrhea than viral prodrome | **More likely to be preceded by diarrhea than viral prodrome | ||
**Consists of ophthalmoplegia and ataxia | **Consists of ophthalmoplegia and ataxia | ||
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==Diagnosis== | ==Diagnosis== | ||
===Required=== | |||
*Progressive [[weakness]] of more than one limb | |||
*Areflexia | |||
===Suggestive=== | |||
*Progression over days to weeks | |||
*Recovery beginning 2–4 wk after cessation of progression | |||
*Relative symmetry of symptoms | |||
*Mild sensory signs and symptoms | |||
*CN involvement ([[Bell's Palsy]], dysphagia, dysarthria, ophthalmoplegia) | |||
*Autonomic dysfunction | |||
**Tachycardia, bradycardia, dysrhythmias, wide variations in BP, postural hypotension | |||
**[[Urinary Retention]] | |||
**[[Constipation]] | |||
**Facial flushing | |||
*Absence of fever at onset | |||
*Albumin-cytological dissociation of [[CSF]] (high protein (>45) and low WBC count (<10))<ref>Bunney EB, Gallagher EJ: Peripheral Nerve Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 105:p 1400-1401.</ref> | |||
##Typical findings on electromyogram and nerve conduction studies | ##Typical findings on electromyogram and nerve conduction studies | ||
##MRI: Selective enhancement of the anterior spinal nerve roots is suggestive<ref>Bunney EB, Gallagher EJ: Peripheral Nerve Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 105:p 1400-1401.</ref> | ##MRI: Selective enhancement of the anterior spinal nerve roots is suggestive<ref>Bunney EB, Gallagher EJ: Peripheral Nerve Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 105:p 1400-1401.</ref> | ||
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==Treatment== | ==Treatment== | ||
*IVIG OR plasmapheresis (provide equivalent but not additive effects) | |||
===Intubation indications=== | |||
*Vital capacity <15mL/kg | |||
*Negative Inspiratory Force < 30 cm H2O | |||
*PaO2 <70 mm Hg on room air | |||
*Bulbar dysfunction (difficulty with breathing, swallowing, or speech) | |||
*Aspiration | |||
==Disposition== | ==Disposition== | ||
===Indications for admission to ICU=== | |||
*Autonomic dysfunction | |||
*Bulbar dysfunction | |||
*Initial vital capacity <20 mL/kg | |||
*Initial negative inspiratory force <–30 cm of water | |||
*Decrease of >30% of vital capacity or negative inspiratory force | |||
*Inability to ambulate | |||
*Treatment with plasmapheresis | |||
*Anticipated clinical course requiring mechanical [[ventilation]] | |||
==See Also== | ==See Also== | ||
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==Source== | ==Source== | ||
[[Category:Neuro]] | [[Category:Neuro]] | ||
Revision as of 02:51, 24 February 2015
Background
- Acute polyneuropathy due to immune-mediated peripheral nerve myelin sheath destruction
- Associated with viral or febrile illness, campylobacter infection, or vaccination
- Symptoms at worst 2-4wk after onset, then plateau for 2-4wk, then remit from wks-months
- Associated with Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus, and Mycoplasma pneumoniae
Clinical Features
- Viral illness -> ascending, symmetric weakness or paralysis and loss of DTRs
- Little or no sensory involvement
- May progress to diaphragm resulting in need for mechanical ventilation (33% of pts)
- Autonomic dysfunction occurs in 50% of pts
- Miller-Fisher Syndrome
- Associated w/ campylobacter infection
- More likely to be preceded by diarrhea than viral prodrome
- Consists of ophthalmoplegia and ataxia
- Weakness is less severe but DESCENDING; disease course milder than classic GBS
Diagnosis
Required
- Progressive weakness of more than one limb
- Areflexia
Suggestive
- Progression over days to weeks
- Recovery beginning 2–4 wk after cessation of progression
- Relative symmetry of symptoms
- Mild sensory signs and symptoms
- CN involvement (Bell's Palsy, dysphagia, dysarthria, ophthalmoplegia)
- Autonomic dysfunction
- Tachycardia, bradycardia, dysrhythmias, wide variations in BP, postural hypotension
- Urinary Retention
- Constipation
- Facial flushing
- Absence of fever at onset
- Albumin-cytological dissociation of CSF (high protein (>45) and low WBC count (<10))[1]
- Typical findings on electromyogram and nerve conduction studies
- MRI: Selective enhancement of the anterior spinal nerve roots is suggestive[2]
Differential Diagnosis
Weakness
- Neuromuscular weakness
- Upper motor neuron:
- CVA
- Hemorrhagic stroke
- Multiple sclerosis
- Amyotrophic Lateral Sclerosis (ALS) (upper and lower motor neuron)
- Lower motor neuron:
- Spinal and bulbar muscular atrophy (Kennedy's syndrome)
- Spinal cord disease:
- Infection (Epidural abscess)
- Infarction/ischemia
- Trauma (Spinal Cord Syndromes)
- Inflammation (Transverse Myelitis)
- Degenerative (Spinal muscular atrophy)
- Tumor
- Peripheral nerve disease:
- Neuromuscular junction disease:
- Muscle disease:
- Rhabdomyolysis
- Dermatomyositis
- Polymyositis
- Alcoholic myopathy
- Upper motor neuron:
- Non-neuromuscular weakness
- Can't miss diagnoses:
- ACS
- Arrhythmia/Syncope
- Severe infection/Sepsis
- Hypoglycemia
- Periodic paralysis (electrolyte disturbance, K, Mg, Ca)
- Respiratory failure
- Emergent Diagnoses:
- Symptomatic Anemia
- Severe dehydration
- Hypothyroidism
- Polypharmacy
- Malignancy
- Aortic disease - occlusion, stenosis, dissection
- Other causes of weakness and paralysis
- Acute intermittent porphyria (ascending weakness)
- Can't miss diagnoses:
Treatment
- IVIG OR plasmapheresis (provide equivalent but not additive effects)
Intubation indications
- Vital capacity <15mL/kg
- Negative Inspiratory Force < 30 cm H2O
- PaO2 <70 mm Hg on room air
- Bulbar dysfunction (difficulty with breathing, swallowing, or speech)
- Aspiration
Disposition
Indications for admission to ICU
- Autonomic dysfunction
- Bulbar dysfunction
- Initial vital capacity <20 mL/kg
- Initial negative inspiratory force <–30 cm of water
- Decrease of >30% of vital capacity or negative inspiratory force
- Inability to ambulate
- Treatment with plasmapheresis
- Anticipated clinical course requiring mechanical ventilation
See Also
Source
- ↑ Bunney EB, Gallagher EJ: Peripheral Nerve Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 105:p 1400-1401.
- ↑ Bunney EB, Gallagher EJ: Peripheral Nerve Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 105:p 1400-1401.