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Guillain-Barré Syndrome

Introduction

GBS is an acute inflammatory demyelinating radiculopathy (and polyneuropathy). There is often considered to be a viral (or other) trigger.

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Triggers

Triggers identified in 60% cases:

Viral
- CMV
- EBV, VZV, HIV, influenza, mumps, measles...
- vaccines

Bacterial
- campylobacter
- mycoplasma
- salmonella

Other
- surgery
- trauma
- cancer

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Disease progression

Natural history:
- Latent period: 2 weeks
- Varible progression: < 1 month (by definition)

Complications & Prognosis:
- 10 % mortality: arrhythmias, sepsis, PE...

Outcome:
- full recovery in 80%
- permanent disability in 10%

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Clinical Features

Required criteria:
- progressive weakness of all 4-limbs
- arreflexia

Supportive features:
- timecourse: progression over 4-weeks
- recovery starts 2-weeks later
- motor: symmetrical signs / bilateral VII palsy / ascending weakness - trunk, diaphragm, bulbar, CNs
- sensory: mild
- ANS dysfunction: urinary retention, labile ABP, arrhythmias

Investigation:
- CSF protein
- CSF WCC: < 10x10⁶/L
- nerve conduction studies: loss of f-waves

NB: The diagnosis can usually be excluded if pure sensory symptoms

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Miller-Fisher variant

Central variant caused by specific antiganglioside antibody.

Features: opthlamoplegia, ataxia, areflexia

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Management

Supportive

Monitor:
- 4-hourly FVC < 2L = call ITU, < 1L = ventilate
- ECG
- bulbar dysfunction: SALT assessment, NBM, NGT

Limb weakness:
- PT
- LMWH: 5000 Units-BD (sub/cut)

Specific
- plasma exchange
- IV Ig: 5-days
- steroids are NOT used

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