common cause of areflexic flaccid type of weakness preceded by some infection

1. Dr Bhupendra Shah
Assistant Professor
Department of internal Medicine
B.P .Koirala institute of Health Sciences

2. History of Gullainn-Barre syndrome

4. Leading cause of acute flaccid
paralysis in developed countries
Ventilation in 25% cases
Death in 4-15% cases
Gullain-Barre Syndrome

5. Leading cause of acute
flaccid paralysis in
developed countries
Ventilation in 25%
cases
Death in 4-15%

6. Delayed transmission through injured nerve

7. Clinical Features
Muscle weakness usually in the legs
-Acute
-Progressive
-symmetric
-usually peak by 2 weeks
Facial weakness
Dysautonomia
Respiratory failure
Sensory deficit:minimal
bladder /bowel:transiently involved

8. Why patient die in Gullain- Barre syndrome

9. Variants of GBS
Acute inflammatory demylinating polyneuropthy
• Acute motor axonal neuropathy
Acute motor sensory axonal
neuropathy
• Miller Fisher variant

10. Investigation
Lumbar puncture Nerve conduction velocity
CSF Analysis
-cell count :normal
-Protein: elevated
Shows slowed
nerve conduction
velocity and
prolonged distal
latency

11. Brighton criteria
1.Bilateral and flaccid weakness of the limbs
2.Decreased /absent DTR in weak limbs.
3.Monophasic ,interval between onset and nadir of weakness
between 12 h and 28 days .
4.Electrophysiological study consistent with GBS.
5.CSF:cytoalbuminologic dissociation
6. Absence of alternatice diagnosis for weakness.

12. Diagnosis certainity
• 1+2+3+4+5+6:level 1
• 1+2+3+4/5+6:level 2
• 1+2+3+6:level 3

13. Treatment
• Setting : usuallly Intensive care unit

14. Treatment options
Immunoglobin(2g/kg:total dose) Plasmaparesis(50ml/kg/session)

15. • Force vital
capacity<20ml/kg
• Max.inspiratory
pressure:<30cm H20
• Max Inspiratory
pressure:<40 cm H20

16. Thank you