Exam Cram

• Acute, peripheral demyelinating disease

• Presentation: ascending paralysis post gastroenteritis

• Diagnosis: clinical

• Management: IV Ig > plasmapheresis +- telemetry/ intubation if cardiac/ lung involvement

Outline

Assessment

History:

• Recent gastroenteritis, classically campylobacter

• Ascending paralysis

Examination:

• Peripheral ascending weakness

• Normal sensation

• Absent bowel sounds, concerning progressed into abdomen

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

• Supportive

  • Intubation if FEV < 1.5

• IVIG > plasmapheresis

Med Reg Notes

ICU Referral

Rapid ICU referral for intubation and intensive cardiovascular monitoring

• FVC < 1.5

• Hypotension

• Tachy/ brady arrhythmias

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.