GUILLAIN-BARRE SYNDROME

Timothy Dycalle P. Manos, RN SO

GUILLAIN-BARRE (GHEE-YA-BUH-RAY)

It is an acute, autoimmune, rapidly progressive, potentially fatal syndrome. It is an autoimmune disease- bodys immune system begins to trigger demyelination of the peripheral nerve. a problem with your nervous system. It causes muscle weakness, loss of reflexes, and numbness or tingling in your arms, legs, face, and other parts of your body.

HISTORY
In early 1900s, Jean Alexander Barre and Georges Guillain were the first neurologists who first characterized the features of GBS.

CASE PRESENTATION
After an upper respiratory infection, Mason Santos, a 35 year old man develops severe lower back pain. Over the next several days, severe, generalized muscle weakness occurs, accompanied by distal parethesia. On physical examination, weakness is evident, but there is no appreciable sensory loss. Nerve conduction studies show evidence of demyelination. Over the next 2 months, the patient recovers with minimal residual sequelae.

OVERVIEW

GBS is a SYNDROME not a DISORDER.

3 PHASES OF GBS:
1.

2. 3.

Acute phase- first definitive symptom develops and ends 1 to 3 weeks later, no further deterioration is noted. Plateau Phase- lasts for several days to 2 weeks. Recovery Phase- coincide with remyelination and axonal process regrowth, lasts from 4 months to 3 years.

RISK FACTORS
ALL AGE GROUPS, BUT YOU'RE AT GREATER RISK IF: YOU'RE A YOUNG ADULT YOU'RE AN OLDER ADULT INFECTION WITH CAMPYLOBACTER MYCOPLASMA PNEUMONIA EPSTEIN-BARR VIRUS INFLUENZA VIRUS HODGKIN'S DISEASE MONONUCLEOSIS HIV, THE VIRUS THAT CAUSES AIDS RARELY, RABIES OR INFLUENZA IMMUNIZATIONS

CLINICAL MANIFESTATIONS
1.

Weakness of extremities- most commonly in legs and arms -first symptom -due to impairment of ventral nerve roots that affects motor function.

2. Tingling and numbness- due to impairment of dorsal nerve roots that affects sensory function..

CLINICAL MANIFESTATIONS
3. Respiratory paralysis- paralysis of internal and external intercostal muscles leads to reduction in functional breathing. 4. Deep tendon reflex lost 5. Paresthesia or loss in sensation

Other symptoms may include: Blurred and double vision Clumsiness and falling Difficulty moving face muscles Muscle contractions Palpitations (sensation of feeling the heart beat) Emergency symptoms (seek medical help right away): Breathing temporarily stops Cannot take a deep breath Difficulty of breathing Difficulty swallowing Drooling Fainting Feeling light-headed when standing

DIAGNOSTIC TESTS
Clinical History 2. Cerebrospinal Fluid analysis (CSF) Findings of: Normal WBC Increase in Protein 3. Nerve Conduction studies-shows slower nerve conduction due to demyelination. -This test measures electrical nerve impulses and functioning in your muscles and nerves. A doctor places two electrodes on your skin, and electrical impulses in the nerve signals are measured when a small shock passes through the nerve.
1.

..Nerve Conduction Studies a. Electromyography-demonstrate repeated firing of the same motor unit instead of widespread sectional stimulation b. Electrophysiologic testing-may reveal marked slowing of nerve conduction velocities.

AIMS TREATMENT AIMS OF OF TREA

A.

B.
C.

Reduce the symptoms Treat the complications Speed up the recovery.

MEDICAL MANAGEMENT
1.

ICU management There is a possible need for intubation. Needs complex management

2. IV Immunoglobulin- to prevent the immune system to attack nerves.

MEDICAL MANAGEMENT
If IV Immunoglobulin is unsuccessful, 3. Plasmapheresis- wherein blood is washed or fresh blood is transfused to the patient. - This treatment involves removing or blocking the proteins, called antibodies, that attack the nerve cells.

TREATMENTS
Other treatments focus on preventing complications: Blood thinners may be used to prevent blood clots. If the diaphragm is weak, breathing support or even a breathing tube and ventilator may be needed. Pain is treated with pain medicines or other medicines. Proper body positioning or a feeding tube may be used to prevent choking during feeding if the muscles used for swallowing are weak. Physical therapy helps keep joints and muscles healthy.

REFERENCES:
http://www.nytimes.com/health/guides/disease/guill ain-barre-syndrome/overview.html Pathophysiology made incredibly easy, 4th edition.