Guillain-Barre Syndrome. William Woodfin MD. K.F. 40 y.o. r/h woman. 3/17 Nausea, diarrhea & severe myalgias Son dxed c rotavirus 1 wk. Previously 4/21 “Creepy-crawlies” legs>arms 4/25 Weakness legs progressing 4/26 Handwriting looks like “hen scratch”. K.F. 40 y.o. woman.
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William Woodfin MD
3/17 Nausea, diarrhea & severe myalgias
Son dxed c rotavirus 1 wk. Previously
4/21 “Creepy-crawlies” legs>arms
4/25 Weakness legs progressing
4/26 Handwriting looks like “hen scratch”
4/28 Admitted to outside hospital.
EMG positive waves in some leg
NCVs absent H-reflexes
F responses & motor latencies wnl
4/29 Transferred to PHD
Hx.: diabetic x 10 yrs.
hypothyroid- treatedx yrs.
no sphincter disrubance
aching pain low back & buttocks
mild postural light headedness
no SOB or palpatations
BP 150/90 P 80 Wt. 250 lbs.
Mild weakness neck flexors
4/5 biceps, grip & interossei- symmetric
2/5 iliopsoas & quadriceps
3/5 hamstrings & adductors
4/5 ankles & toes- extensors & flexors
DTRs- biceps, BR, knees are trace c
reinforcement. Triceps & ankles
F to N- intact
Gait- not testable
H/H 10.3/33.5 c microcytic indices
A1c Hgb 10.1
Serum immunofixation- wnl. No IgA def.
FVCs- consistently 4+ liters
LS spine s & c contrast- no nerve root enhancement
Treated c IVIG 0.4 gms/kgm daily x 5
Strength fluctuated only mildly
Blood sugars ok in AM, high in afternoons
Repeated NCVs show mild dispersion of F waves
Transferred back to referring hospital 5/6
Ambulating fairly well c walker. Strength
Still bothered by “creepy-crawlies”
2. Fairly symmetric weakness in the legs, later the arms and, often, respiratory and facial muscles
3. Dimunition and loss of the DTRs
4. Albuminocytologic dissociation
5. Recovery over weeks to monthsThe typical illness evolves over weeks usually following an infectious disease and involves:
Late 19th century: examination of the reflexes had become a part of the neurologic exam with appreciated as a sign of neuropathy based on observations in tabes dorsalis areflexia
HIV, Hepatitis, CMV, WNV
Bacterial: Campylobacter jejuni,
Mycoplasma, E. coli
Parasitic: Malaria, Toxoplasmosis
2. Related to brainstem encephalitis, Bickerstaff
3. CNS demyelination in association with GBS
DVT & PE
Positioning & Skin care
MIF < 25 cm water
IV Methylprednisilone 500 mgm/day x 5.
May cause relapse
Avoid with autonomic instability
? Antiidiotypic antibody action
? Inhibition of cytokines
? “Sponging” of complement
? Binding to Fc receptors so macrophages