BASIC INFO: Guillain-Barre Syndrome in Neuro Critical Care Unit

🔵is an Acute Inflammatory Demyelinating Polyneuropathy (AIDP) 

🔵There will be diffuse weakness, areflexia and albuminocytologic dissociation. 

🔵In ~60% there can be preceding upper respiratory infection or diarrhea with 30% of these cases attributed to Campylobacter jejuni  

🔵Neurologic symptoms: numbness, paraesthesias, dysesthesias and progressive, bilateral symmetric weakness that progresses over hours to days and peaks in a few weeks. 

🔵normal or hyperreflexia in the initial phase changes to  areflexia. 

🔵CSF : elevated protein without pleocytosis (albuminocytologic dissociation is seen with only in 50% of patients during their first week of illness and up to 75% by the third week)

🔵Lumbar puncture is necessary to rule out infectious diseases and malignancies. 

🔵Medical complications : Respiratory failure and need for mechanical ventilation, aspiration pneumonia, sepsis, arrhythmias, cardiac arrest, and dysautonomia. 

🔵Screening for dysphagia and frequent bedside spirometry is necessary to prevent aspiration and further respiratory compromise. 

🔵They often require narcotics, gabapentin or carbamazepine to manage their acute pain (A small portion of patients will continue to experience radicular, arthralgia or meningitic pain up to one year later.) A dual approach of psychosocial support and SSRI therapy is recommended. 

🔵 both PLEX and IVIG are effective therapies for patients with GBS. 

🔵 Patients admitted within two weeks of symptom onset, bed bound on admission, and those that have minimal comorbidities can be considered for PLEX first. 

🔵 IVIG is may be easier to administer, especially when placement of a central line is not readily available. 

🔵 A Cochrane systematic review published in 2012 concluded that PLEX is more effective than supportive care, IVIG may be slightly safer, and combination therapy was not more effective than monotherapy 

Reference :

>Jacob S, Viegas S, Lashley D, Hilton-Jones D (2009) Myasthenia gravis and other neuromuscular junction disorders. Pract Neurol 9: 364-371. 

>Hughes RA, Swan AV, van Doorn PA (2012) Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev. Wil ey Online Library 7.

>Bedside Critical Care Guide / Ramzy H Rimawi

#GBS , #GBSICU , #PLEX, #neuroicu ,#neurology ,#anaesthesia ,#anesthesiologist