Guillain Barre Syndrome - Causes, Symptoms and Treatment
What is Guillain Barre Syndrome?
Also known as infectious polyneuritis, Landry-Guillain-Barre syndrome, and acute idiopathic polyneuritis, GuillainBarre syndrome is an acute, rapidly progressive, and potentially fatal form of polyneuritis that causes muscle weakness and mild distal sensory loss. This syndrome can occur at any age but is most common between ages 30 and 50; it affects both sexes equally. Recovery is spontaneous and complete in about 95% of patients, although mild motor or reflex deficits in the feet and legs may persist. The prognosis is best when symptoms clear between 15 and 20 days after onset.
What are the Causes of Guillain Barre Syndrome?
The precise cause of Guillain-Barre syndrome is unknown, but it may be a cellmediated immune response with an attack on peripheral nerves in response to a virus. The major pathologic effect is segmental demyelination of the peripheral nerves. Because this syndrome causes inflammation and degenerative changes in both the posterior (sensory) and the anterior (motor) nerve roots, signs of sensory and motor losses occur simultaneously.
About 50% of patients with GuillainBarre syndrome have a recent history of minor febrile illness, usually an upper respiratory tract infection or, less often, gastroenteritis. When infection precedes the onset of Guillain-Barre syndrome, signs of infection subside before neurologic features appear. Other possible precipitating factors include surgery, rabies or swine influenza vaccination, viral illness, Hodgkin's disease, or some other malignant disease, and systemic lupus erythematosus.
What are the Signs and Symptoms of Guillain Barre Syndrome?
Muscle weakness, the major neurologic sign, usually appears in the legs first (ascending type) and then extends to the arms and facial nerves within 24 to 72 hours. Sometimes muscle weakness develops in the arms first (descending type) or in thc arms and legs simultaneously. In milder forms of the disease, muscle weakness may affect only the cranial nerves or not occur.
Paresthesia, another common neurologic sign, sometimes precedes muscle weakness but vanishes quickly. Some patients with the disorder never develop this symptom.
Other clinical features include facial diplegia (possibly with ophthalmoplegia [ocular paralysis]), dysphagia or dysarthria and, less often, weakness of the muscles supplied by cranial nerve XI (spinal accessory nerve). Muscle weakness develops so quickly that muscle atrophy doesn't occur, but hypotonia and areflexia do. Stiffness and pain in the form of a severe charley horse often occur.
The clinical course of Guillain-Barre syndrome is divided into three phases:
Significant complications of GuillainBarre syndrome include mechanical ventilatory failure, aspiration pneumonia, sepsis, joint contractures, and deep vein thrombosis. Unexplained autonomic nervous system involvement may cause sinus tachycardia or bradycardia, hypertension, orthostatic hypotension, and loss of bladder and bowel sphincter control.
Diagnosis for Guillain Barre Syndrome
A history of preceding febrile illness (usually a respiratory tract infection) and typical clinical features suggest Guillainbarre syndrome. Several days after onset of signs and symptoms, the cerebrospinal fluid (CSF) protein level begins to rise, peaking in 4 to 6 weeks, probably as a result of widespread inflammatory disease of the nerve roots. The CSF white blood count remains normal, but in severe disease, CSF pressure may rise above normal.
Probably because of predisposing infection, the complete blood count shows leukocytosis with the presence of immature forms early in the illness, but blood study results soon return to normal. Electromyography may show repeated firing of the same motor unit, instead of widespread sectional stimulation. Nerve conduction velocities are slowed soon after paralysis develops. The diagnosis must rule out similar diseases such as acute poliomyelitis.
Treatment for Guillain Barre Syndrome
Primarily supportive, treatment consists of endotracheal intubation or tracheotomy if the patient has difficulty in clearing secretions.
A trial dose of prednisone may be given if the course of the disease is relentlessly progressive. If prednisone produces no noticeable improvement after 7 days, the drug is discontinued. Plasmapheresis is useful during thc initial phase but offers no benefit if begun 2 weeks after onset.
Special Considerations and Prevention Tips for Guillain Barre Syndrome
HEALTH CARE | ABOUT US | CONTACT US | BLOG
© 2005 Online-Health-Care.com. All rights reserved.
Disclaimer: Online-Health-Care.com is for informational purposes only and is not intended to act as a substitute for a professional healthcare practitioner advise. For specific medical advice, diagnoses, and treatment, please consult your doctor. We will not be liable for any complications, injuries or other medical accidents arising from or in connection with the use of or reliance upon any information on this web site.