Step I Guillian-Barre

[DrPak]

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I had a question on usmlerx in which a patient developed Guillian-Barre with paralysis in his limbs (feet and hands) going developing towards the center. I thought Guillian-Barre was an ascending paralysis from the feet on up, not from periphery to center.

Also, do we really need to know the infections associated with Guillian-Barre? Is that HY?

 

[Jack P]

It seems to me that since there can be a variety of antecedent events in AIDP (GBS) the hy fact is to be able to recognize that it is a immune related neuropathy. Usually GBS happens within 1-3 weeks of an infectious illness (viral (CMV, HBV, HSV, HIV others) or bacterial (Campylobacter jejuni and Mycoplasma pneumonia)) and is characterized as an ascending neuropathy with areflexia, that may lead to respiratory paralysis. I don't think that the boards will ask for the variants of GBS (Miller Fischer syndrome, etc) but I think the HY point is to note that ascending paralysis of short duration post infection is GBS, the etiology is less important. If they ask for therapy its IVIg or plasmapheresis to clear the protein complexes.

 

[whodunit]

It is an ascending paralysis.. this is a good site for more info on gb and its variants...

http://www.jsmarcussen.com/gbs/uk/overview.htm

 

[Shodddy18]

I actually had a patient last week who was diagnosed w/ miller-fisher syndrome... a varient of guillan barre. He presented w/ opthalmoplegia and ataxia... wish I was smart enough to come up w/ that diagnosis. The neurologist definately impressed me.

 

[Idiopathic]

Think of the paralysis as from extremities in, i.e. picture us on all fours. It can start in the arms and move down, the legs and move up, or all four and move to the center.

As far as the HY points, I would say that association with pathogens is the most HY thing about GB. Know association with C. Jejuni and the flu vaccine mainly, but HIV/AIDS, mono and some others come to mind.