Guillain-Barré Syndrome

Guillain-Barré Syndrome in MRCP

This is a popular disease in MRCP part 1 and 2. In part 2, question about GB syndrome would be asked based on CSF interpretation.
GB is an acute polyneuropathy mainly affecting motor neuron. It is usually demyelinating type. Patient usually presents after recent viral/bacteria infections.

Trigerring Agents

Campylobacter jejuni ( usually cause diarrhoe)
CMV
EBV
HIV
mycoplasma species

Clinical Presentations
Acute onset of leg weakness and ascends to the upeer limbs. Peripheral numbness is possible.

Physical Signs
Lower motor lesion of both lower limbs ( sensory loss is distal and minimal)
Papilloedema
Autonomic dysfunction ( may lead to cardiac arrhytmia and death)
Cranial nerves involvement ( Miller Fisher variant- ophtalmoplegia with ataxia)

Investigations
For Miller Fisher, autoantibody GQ1B can be present.
CSF ( Cerebral spinal fluid ) shows high protein
Nerve conduction shows demyelinating pattern
Remember that to monitor patient ( in case of respiratory muscles involvement), you should monitorthe FVC ( spirometry) NOT Peak Expiratory Flow Rate (PEFR)

Treatment
IV Immunoglobulin. Plasma exchange can be considered.

Tips for MRCP:
1)If the weakness lasts longer than months, always consider CIDP ( chronic inflammatory demyelinating polyneuropathy.)
2) Major cause of death in patients with GBS is due to autonomic dysfunction and cardiac arrhytmia!