IN THE NAME OF GOD GUILLAIN BARRE SYNDROM

IN THE NAME OF GOD

GUILLAIN BARRE SYNDROM (GBS) Z. Vaseie MD Emergency Medicine Resident

Guillain Barre Syndrom (GBS) §Group of autoimmune conditions involving demyelination and acute axonal degeneration of peripheral nerves §Usually preceded by triggering event, e. g. , infection(campylobacter jejuni), vaccination §Leading cause of acute flaccid paralysis, progressive symmetrical ascending weakness + decreased DTR+variable sensory finding +sparing anal sphincter §All ages, but rare in infancy

Guillain Barre Syndrom (GBS) § 32% have all 4 extrimities affected at the time of presentation § 10% have weakness that begins in the upper extrimities § Some form of cranial nerve involvement(usually 7)

Variety of GBS 1. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) 2. Acute motor axonal neuropathy (AMAN) 3. Acute motor sensory axonal neuropathy (AMSAN) 4. Miller-Fisher syndrome (ophtalmoplegia, ataxia, areflexia) 5. Acute panautonomic neuropathy

Paraclinic: § Electrophysiologic testing(EMG-NCV) § CSF: elevated protein (>45 mg/ dl) with & (white cell counts < 10/cc ) after 7 to 10 days

Paraclinic: § MRI: selective enhancement of the anterior spinal nerve roots is suggestive but not diagnostic § Nerve Biopsy: mononuclear inflammatory infiltration

Treatment: Assessment of respiratory function § IVIG 2 gr/kg/day for 2 days § Plasma Exchange § Corticosteroids are no longer recommended

Out come: §Weakness reaches nadir at 2 -4 weeks §Spontaneous resolution occurs over weeks to months. § 2% _ 5% mortality