Exam Cram

• Definition: GBS is an acute demyelinating disease of the peripheral nervous system

• Presentation: ascending paralysis post viral infection, typically gastroenteritis

• Diagnosis: clinical- history, examination, investigations- protein in CSF

• Management: IV Ig > plasmapheresis +- telemetry/ intubation if cardiac/ lung involvement, monitor in HDU with breath counting

Outline

Background

• GBS is a serious complication of an acute infection 

• Senior input is required due to risk of death from respiratory arrest

• May require monitoring in HDU

Assessment

History:

• Recent gastroenteritis, classically campylobacter

• Global fatigue

Examination:

• Peripheral ascending paralysis, often in all four limbs

• Normal sensation

• Absent bowel sounds, concerning progressed into abdomen

• Breath count < 15 requires intubation, > 50 is normal

Investigations

• FEV < 1.5 indication for ICU 

• CSF: raised protein

• Nerve conduction studies: multiple site conduction block 

Diagnosis

Diagnostic criteria: clinical

Differentials: Miller Fisher Syndrome , Botulism (< 48hrs), Myasthenia Gravis 

Management

Acute

• Supportive

  • Intubation if FEV < 1.5

• IVIG > plasmapheresis

Chronic

• Physical exercise rehab for muscle wasting from bed rest

Med Reg Notes

ICU Referral

Rapid ICU referral for intubation and intensive cardiovascular monitoring

• FVC < 1.5

• Hypotension

• Tachy/ brady arrhythmias

• Breath count < 15 requires consideration for intubation, < 50 requires HDU for monitoring

Management Notes

• IVIG is usually more practical to administer so given in preference to plasma exchange, the latter only done if IVIG isn't possible but both has similar efficacy

• Steroids: have no role in management for GBS. 

• Nebulizers: do not affect FVC progression

• Rituximab can be considered by senior specialists

Page written in 2024.