Guillan-Barre Syndrome

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Guillain–Barré syndrome (GBS) is potentially fatal, immune-mediated acute-onset ascending  sensorimotor neuropathy usually triggered by infections. Timely recognition, diagnosis, and prompt  referral to a centre equipped to provide ventilatory support is essential to improve mortality and  minimize long term morbidity. 

Clinical presentation

  • Rapid ascending bilateral lower limb weakness
  • Little or no sensory deficits
  • Evolving respiratory distress

Investigations 

  • FBP, serum electrolytes
  • CSF analysis-albuminocytologic dissociation (↑ protein without pleocytosis)          Emergency MRI to exclude acute spina cord inflammation or compression

Pharmacological management 

Admit to ICU and provide ventilatory support to all patients with evolving respiratory distress or  severe autonomic cardiovascular dysfunction  

S: human immunoglobulin G (IV) 0.4g/kg 24hourly for 5days (started within 2weeks of disease onset) 

For severe cases, consider 

S: plasma exchange 200-250ml plasma/kg body weight for 5sessions (started within 4weeks of disease onset) 

Monitor respiratory function-patient is deemed at risk of respiratory failure if the vital capacity is  <20ml/kg, the maximum inspiratory pressure is <30cmH2O or the maximum expiratory pressure is  <40cmH2O 

Non-pharmacological management 

  • Provide rehabilitation-exercises to assist ambulation
  • Assisted ambulation devices—e.g., high back wheelchairs