Guillain Barre Syndrome - NEET PG Medicine

Guillain Barre syndrome is a serious medical condition that can cause rapid and significant muscle weakness, leading to paralysis and respiratory failure in severe cases. GBS is an autoimmune disorder in which the body's immune system attacks the peripheral nerves, causing muscle weakness and other symptoms. Understanding the immunopathology of GBS is important for understanding the underlying mechanisms of the disease.

In this post, we have covered this important medicine topic briefly for the NEET PG exam preparations. Read on. 

Overview

• The diagnostic criteria used to identify GBS is Brighton criteria
• Revised McDonald criteria are used for identification of Multiple sclerosis
• GBS: Manifestation occurs on the demyelination of peripheral nervous system(Peripheral nerves & spinal cord)

• Antibody responsible: anti GM1 

Clinical Presentation

• In GBS after two weeks, patient presents with
  • Patient cant able to move legs (Tone decreased)
  • Bilateral Ascending symmetrical flaccid paralysis 
  • Equal paralysis of left & right leg (magnitude of power loss of both side will be identical)- Quadriplegia 
  • Truncal paralysis
  • Demyelination of cervical spine(respiratory paralysis)
  • Diaphragmatic paralysis due to demyelination at C_3, C_4, C₅ and Neck floppiness.
  • Due to facial nerve involvement leads to 7^th nerve palsy - Facial diplegia .
• The paralysis goes from downwards to upwards.

• Important information 
  • Facial diplegia
    • Sarcoidosis
    • Melkersson Rosenthal Syndrome
    • Guillain-Barre syndrome

Also Read: Neurocysticercosis : Clinical Picture, Diagnosis, Treatment

Criteria                          

• Bilateral ascending symmetrical flaccid paralysis
• In GBS, the bladder and bowel is spared.

• Important information 
  • D/D: Transverse myelitis
    • Bladder & bowel involvement
    • Root pain
    • Urinary incontinence
• Diagnostic test for GBS: Nerve conduction velocity which shows increased latency (Electrophysiological findings)
• Course of progression of GBS: 12 hours - 28 days, patients starts developing respiratory insufficiency
• Monophasic illness
• Lumbar puncture: Albumino-cytological dissociation
  • CSF opening pressure is normal 
  • Cells are normal 
  • Sugar is normal 
  • Color is normal 
  • Protein are increased
• Earliest Manifestation is Distal areflexia 

Also Read: Pectus Excavatum: Causes, Symptoms, Risk Factors, Diagnosis and Treatment

Brighton Diagnostic Criteria for GBS      

• Bilateral and flaccid weakness of limbs
• Decreased or absent deep tendon reflexes in weak limbs
• Monophasic course and time between onset-nadir = 12 hours to 28 days
• Absence of alternative diagnosis for weakness
• CSF cell count <50/ml
• CSF protein concentration >60 mg/dL
• Nerve conduction study findings consistent with one of the subtypes of GBS (latency period is increased)

Treatment                             

• IV Immunoglobulins (DOC)
• Plasmapheresis 
  • Efficacy of both IVIg and Plasmapheresis is equal

Also Read: EPILEPSY AND Electroencephalography (EEG) : NEET PG Medicine

Comparison  

• Multiple sclerosis
  • Acute: Methylprednisolone
  • Prevention: Beta interferon
• Parkinson’s disease: Levodopa + Carbidopa

Also Read: Cardiopulmonary Resuscitation: How to Perform CPR, Types of CPR

To study this topic in detail, you can access our detailed video lectures and study notes available on the PrepLadder app.