NEUROLOGY + NEUROSURGERY
GUILLAIN-BARRE SYNDROME + MIMICS
PromptDifferential of lower limb weakness
ResponseSpine:
Cauda equina syndrome
Neuro Syndromes:
Guillain Barre Syndrome
Transverse Myelitis
Functional
Hypokalemic periodic paralysis (12 marks on 2024.2 written!)
Cauda equina syndrome
- Lower back pain, trauma
- Areflexia, sadddle parasthesia, decreased anal tone, urinary retention
- Cancer, trauma, IVDU
- Hyperreflexia, thoracic back pain, spinal level injury on exam
Neuro Syndromes:
Guillain Barre Syndrome
- Ascending weakness, recent GI illness
- Areflexia, minimum sensory change
- History of MS, other focal neurology (Optic neuritis)
- UMN signs, incomplete neurology
Transverse Myelitis
- Post viral illness
- Spinal level on examination
Functional
- Inconsistent history and examination
Hypokalemic periodic paralysis (12 marks on 2024.2 written!)
PromptGuillaine-barre syndrome clinical presentation
ResponseHistory
Prior infectious illness (Campylobacter)
Symmetric ascending weakness
Examination
LMN findings - areflexia
Sensory typically preserved
Ascending
Assess for respiratory muscle involvement
Investigation
MRI - no lesion (Although may show enhancement of anterior spinal nerves)
CSF - Albumin-cyotological dissociation (= High protein, low WCC)
Nerve conduction studies - Peripheral demyelination
FVC - low
Anti-ganglioside antibodies - raised
C. Jejuni serology may be positive
Prior infectious illness (Campylobacter)
Symmetric ascending weakness
Examination
LMN findings - areflexia
Sensory typically preserved
Ascending
Assess for respiratory muscle involvement
Investigation
MRI - no lesion (Although may show enhancement of anterior spinal nerves)
CSF - Albumin-cyotological dissociation (= High protein, low WCC)
Nerve conduction studies - Peripheral demyelination
FVC - low
Anti-ganglioside antibodies - raised
C. Jejuni serology may be positive
PromptLife threatening complications of GBS
ResponseRespiratory failure - monitor FVC regularly
Autonomic dysfunction - cardiac monitoring, regular BP measurement
Autonomic dysfunction - cardiac monitoring, regular BP measurement
PromptFVC importance in Guillaine Barre Syndrome
Response>20 mL/kg - ward based care
15-20 mL/kg - observe in ICU/HDU
<15 mL/kg - mechanical ventilation likely required
(CO2 retention on serial gasses is also reasonable to monitor)
Other indications for intubation
Bulbar weakness (CN IX>>XII involvement)
Inability to lift head
UL weakness
tachypnoea
15-20 mL/kg - observe in ICU/HDU
<15 mL/kg - mechanical ventilation likely required
(CO2 retention on serial gasses is also reasonable to monitor)
Other indications for intubation
Bulbar weakness (CN IX>>XII involvement)
Inability to lift head
UL weakness
tachypnoea