-Guillain Barré syndrome.

Guillain Barré syndrome

Aetiology(theories):-

• Postinfection:50% of cases have preceding respiratory or GIT viral infection.
• Post vaccination:following vaccination against swine flu virus.
• Lymphoma.
• Autoimmune theory.

Clinical Picture:-
1-Initial febrile illness.
2-Motor affection:-

• Bilateral symmetrical ascending affection of both lower limbs,trunk,upper limbs,Bulbar muscles,facial muscles then diphragm and respiratory muscles.
• The Affection is proximal more than distal in adult.
• The Affection is proximal more than distal in infant and childrens.
• Weakness is associated with hypotonia and areflexia.
  

3-Sensory affection:-
Glove and stoke hyposthesia.
4-Autonomic affection:-
Incontinence of urine or retention.
Abnormal pulse and blood pressure.
5-Papilloedema (Due to increase CSF proteins and decrease CSF absorption).

Investigations:-

• CSF:- cytoalbuminous dissociation.
• Nerve conduction velocity:- decreased.
• EMG:- acute dennervation of muscle.

Treatment:-   "Spain"

• Subcutaneous heparin to prevent DVT.
• Plasmapharesis (must be done in the first 2 weeks).
• Assisted ventilation.
• Intravenous immunoglobulins(IVIG):0.4g/KG/day for successive 5 days.
• Nasogastric tube feeding for bulbar palsy.

Dr Ibrahim

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