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Gullain barre syndrome

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

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Gullain barre syndrome

  1. 1. Dr Bhupendra Shah Assistant Professor Department of internal Medicine B.P .Koirala institute of Health Sciences
  2. 2. History of Gullainn-Barre syndrome
  3. 3. Leading cause of acute flaccid paralysis in developed countries Ventilation in 25% cases Death in 4-15% cases Gullain-Barre Syndrome
  4. 4. Leading cause of acute flaccid paralysis in developed countries Ventilation in 25% cases Death in 4-15%
  5. 5. Delayed transmission through injured nerve
  6. 6. 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
  7. 7. Why patient die in Gullain- Barre syndrome
  8. 8. Variants of GBS Acute inflammatory demylinating polyneuropthy • Acute motor axonal neuropathy Acute motor sensory axonal neuropathy • Miller Fisher variant
  9. 9. Investigation Lumbar puncture Nerve conduction velocity CSF Analysis -cell count :normal -Protein: elevated Shows slowed nerve conduction velocity and prolonged distal latency
  10. 10. 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.
  11. 11. Diagnosis certainity • 1+2+3+4+5+6:level 1 • 1+2+3+4/5+6:level 2 • 1+2+3+6:level 3
  12. 12. Treatment • Setting : usuallly Intensive care unit
  13. 13. Treatment options Immunoglobin(2g/kg:total dose) Plasmaparesis(50ml/kg/session)
  14. 14. • Force vital capacity<20ml/kg • Max.inspiratory pressure:<30cm H20 • Max Inspiratory pressure:<40 cm H20
  15. 15. Thank you