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Guillain –barre syndrome

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Text of Guillain –barre syndrome

  • SATURDAY FORUM 6th AUGUEST 2005A .S HENNAYAKE

  • PC Facial Numbness 1 dayNumbness of both UL & LL HPCHe was Well 10 days back and Developed fever which was associated with chills and subsided 5 days back .He was free of fever for Next 5 days except for a Non productive coughThen he Developed numbness of both LL & UL . And developed weakness of both LL & ascended both UL , Meanwhile he noticed BL facial numbness & weakness.He had Immunization for poliomyelitis ,No Hx of food poisoning . Bowel habits & Urinary habits normal

  • PMH-No Hx of similar illness , DM or Connective tissue diseaseFH-No Hx of similar illness , autoimmune disease , , connective tissue disease,DM -FatherDH - NADSH School boy, living with Mother & Father .no social problems.

  • Summery14 year old school boy presented with Numbness & Weakness of Both UL & LL & Facial Weakness following a febrile Illness. Bowel habits & Urinary habits Normal .Father is having DM.FH of DM ,Immunization for poliomyelitis done

  • OE Obese AfebrileCVSPR - 80 minBP 130 /70 mmhgHt S 1 ,S2 NormalRSRR -35 min Chest movements symmetricalBreath holding counting 30 VB present

  • MotorPower BL UL Grade 4 BL LL Grade 2Tone BL UL reduced BL LL reducedReflexes BL UL Reduced BL LL absentPlantar BL down Joint position sense absentGait- difficult to check

  • ABD- Soft Liver ,spleen not palpable Kidneys not Balatable NO FF ,BS+CNS-Conscious ,Rational BL facial weakness + No Neck stiffness Fundi Normal No cerebellar signs No Sensory Loss.

  • IxHb 10 . 3 gdlPcv 31 %WBC 11 x10 9 N 75 % L 21 % E 2% M 2%SSS

  • Summery14 year old school boy presented with Numbness & Weakness of Both UL & LL & Facial Weakness following a febrile Illness. Bowel habits & Urinary habits Normal .Father is having DM.FH of DM ,Immunization for poliomyelitis doneOE Obese, BL facial weakness and flaccid paralysis of both Upper & Lower limbs with absent reflexes and joint position senses

  • ESR 10 mmhUFR- NADBU- 4.2 mmolSE Na 144meql K 4.5 meqlS. Protein -6 gdl A -3.9gdl G -2.1gdlCXR - NADECG -NAD

  • RBS-100mgdlCSF Sugar 77.7gdlProtein 160 mg dlCells L 5 RBC 3 Nerve conduction -

  • GUILLAIN BARRE SYNDROMEIncidence 8.5 cases per million3/10000 per yMonophasic illness Demyelinating neuropathy ,Rarely axonal Does not recurProbably has auto allergic process to myelin sheaths

  • Usually follows Upper respiratory tract infections ,Entero virus ,EB virus Camphylobactor jejuni ,Mycoplasma ,CMV , HIV Clinical featuresAscending paralysis lasting for few days to 4 weeks ( subacute 8 weeks)Can present with lumbar or spinal painMotor paralysis distal , proximal or Respiratory musclesSome sensory ,tactile , vibratory sensation and postural sensibility

  • Cranial nerves can affect ( facial)Bulbor involvement can occur Can present as complete Locked in stateAutonomic symptoms like atonic Bladder ,illeus Hypertension , orthostatic HypotensionPapilloedema ( CMV)Combination of external opthalmoplagia ,ataxia & tendon areflexia ( Miller Fisher syndrome )

  • IXHistology Demeyelination maximal spinal roots , peripheral nerves CSF-Protein elevated , no pleocytosisElectrophysiological changes ( marked slowing of conduction velocities ,delayed later responses ,prolong distal latencies ,dispersion of evoked responses and evidence of conduction block)

  • Diagnosis Clinical groundsConfirmed by nerve conduction studies and CSFCourse and managementParalysis progress rapidlyMay require ventilatory supportSubcutaneous Heparin ( venous thrombosis)High dose gamma globulin (IGA deficiency should be checked )Plasmapheresis Corticosteroids no value

  • Spontaneous recovery begins in few days to 3 weeks from the onset with without treatmentProlong ventilation may be necessaryImprove over few months Improvement may be complete or incomplete

  • DDPoliomyelitis BotulinismCord compressionPrimary muscle diseaseTransverse Mayelitis