GUILLAIN-BARRE SYNDROME

LAURA WILLIAMS, KELLI KACHMAR, NATALIE BREUER, SUZY CARTER, ALEXIS DYAMOND

PATHOPHYSIOLOGY

As of right now, no one knows the exact reasoning behind Guillain-Barré syndrome. What scientists do know is when an infection or virus enters the body in an individual with Guillain-Barré syndrome, the body’s immune system is tricked into thinking that its own nerve cells are foreign cells. This autoimmune disease occurs when the body’s immune system begins to destroy the myelin sheath of axons of peripheral nerves. When these myelin sheaths are destroyed, the speed of conduction along the nerves is disrupted. When these nerves can’t fire correctly, the muscles lose their ability to function properly. The conduction between the brain and muscles is usually disrupted and can cause inappropriate senses for that individual because there is not proper translation through the nerve network. This is why individuals with Guillain-Barré syndrome experience weakness and a tingling sensation in their lower extremities moving to the upper body.
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CLINICAL MANIFESTATIONS

  • Presents 2-4 weeks after a benign respiratory or gastrointestinal illness
  • Finger dysesthesias (abnormal sensation, burning/painful sensation under skin with extreme sensitivity to touch)
  • Proximal muscle weakness of the lower extremities, may involve arms, truncal muscles, cranial nerves, muscles of respiration
  • May present as pure motor dysfunction or acute dysautonomia
  • Loss of tendon reflexes in upper and lower extremities
  • Uncoordinated movement
  • Hypotension
  • Abnormal heart rate
  • Blurred/double vision
  • Symptoms can increase in intensity until certain muscles cannot be used at all, in severe cases leads to paralysis

Guillain-Barre Syndrome-Mayo Clinic

RISK FACTORS

  • Usually triggered by a benign gastrointestinal or respiratory infection; may be triggered by improper immune response to illness
    INFECTIONS ASSOCIATED WITH GUILLAIN-BARRE
  • Campylobacter jejuni- most common cause of diarrhea in the United States, often found in undercooked foods (especially poultry); axons are attacked by antibodies against Campylobacter, reacting with proteins of the peripheral nerves and causing damages
  • Influenza
  • Cytomegalovirus- strain of the Herpes virus
  • Epstein-Barr virus infection (mononucleosis)
  • Mycoplasma pneumonia- caused by bacteria-like organisms
  • HIV/AIDS
  • Hodgkin disease
  • Systemic lupus erythomatosus
    OTHER FACTORS
  • Recent surgery (due to weakened immune system)
  • Slightly increased risk for men and older adults
  • Associated with influenza vaccinations and childhood vaccinations, but this is rare

DIAGNOSTICS

  • Can be difficult to diagnose in early stages and can be similar to other neurological disorders and are different for every person
  • Medical history and physical exam
  • Spinal tap/ lumbar puncture: small amount of fluid is withdrawn from the spinal canal in the lower back. It is then tested for a type of change that occurs in people who have the disease
  • Electromyography: thin needle electrodes are inserted into the muscles of certain muscles, the electrodes measure nerve activity in the muscles
  • Nerve conduction studies- electrodes are taped to skin above nerves. A small shock is passed to the nerve to measure speed of nerve signals.
  • Doctor will assess if symptoms appear on both sides of body which is common in disease, reflexes in knees are often lost, symptoms appear slower and over time

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TREATMENTS

  • No cure, but treatments can help with recovery and reducing severity
  • Plasma exchange- liquid portion of blood is removed and separated from blood cells. The blood cells are put back into the body, which produces more plasma to make up for what was removed.
  • Immunoglobin therapy- immunoglobin with healthy antibodies from blood donors given through IV; can block damaging antibodies
  • Use of steroid hormones but is not as effective
  • Most critical treatment is placing patient on ventilator and heart monitor to assist body functions since their nervous system is recovering. Usually treated in ICU.