Gullain barre syndrome
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Transcript of Gullain barre syndrome
Dr Bhupendra ShahAssistant Professor
Department of internal MedicineB.P .Koirala institute of Health Sciences
History of Gullainn-Barre syndrome
Leading cause of acute flaccid paralysis in
developed countries
Ventilation in 25% cases
Death in 4-15% cases
Gullain-Barre Syndrome
Leading cause of acute flaccid paralysis in developed countries
Ventilation in 25% cases
Death in 4-15%
Delayed transmission through injured nerve
Clinical FeaturesMuscle weakness usually in the legs-Acute -Progressive-symmetric-usually peak by 2 weeks
Facial weakness
Dysautonomia
Respiratory failure
Sensory deficit:minimal
bladder /bowel:transiently involved
Why patient die in Gullain- Barre syndrome
Variants of GBS
Acute inflammatory demylinating polyneuropthy
• Acute motor axonal neuropathy
Acute motor sensory axonal neuropathy
• Miller Fisher variant
Investigation
Lumbar puncture Nerve conduction velocity
CSF Analysis -cell count :normal-Protein: elevated
Shows slowed nerve conduction velocity and prolonged distal latency
Brighton criteria1.Bilateral and flaccid weakness of the limbs
2.Decreased /absent DTR in weak limbs.
3.Monophasic ,interval between onset and nadir of weakness between 12 h and 28 days .
4.Electrophysiological study consistent with GBS.
5.CSF:cytoalbuminologic dissociation
6. Absence of alternatice diagnosis for weakness.
Diagnosis certainity
• 1+2+3+4+5+6:level 1
• 1+2+3+4/5+6:level 2
• 1+2+3+6:level 3
Treatment
• Setting : usuallly Intensive care unit
Treatment options
Immunoglobin(2g/kg:total dose) Plasmaparesis(50ml/kg/session)
• Force vital capacity<20ml/kg
• Max.inspiratory pressure:<30cm H20
• Max Inspiratory pressure:<40 cm H20
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