Tattered

Nerve
16th PBL by PBL 1
WHAT IS GUILLAIN - BARRE SYNDROME?
DEFINITION CAUSES

Body's immune system Diarrhea or a respiratory illness

attacks part of the About 2 in every 3 people with GBS
peripheral nervous system had diarrhea or a respiratory
Can affect the nerves that illness several weeks before
control muscle movement developing GBS symptoms
Can result in muscle Infection with Campylobacter
weakness jejuni, which causes diarrhea, is
People of all ages can be one of the most common causes
affected, but it is more of GBS.
common in adults and in
males Viral infections
Some people with GBS had the flu
or infections with cytomegalovirus,
Epstein Barr virus, Zika virus, or
other viruses.

Vaccination (rare)

Diagnosis of GBS
 Suspect of GBS --->
rapidly progress bilateral limb
weakness and/ or sensory
deficits
hyporeflexia / areflexia
facial or bulbar palsy
ophthalmoplegia and ataxia
criteria that support diagnosis ? -
How to diagnose GBS?
Check diagnosis criteria
Routine laboratory tests
CSF examination
Electropsychological studies
Progressive phase lasts from days to 4 weeks
(usually <2 weeks)
Relative symmetry of symptoms and signs
Relatively mild sensory symptoms and signs
(absent in pure motor variant)
criteria that deny diagnosis ? -
Increased numbers of mononuclear or
polymorphonuclear cells in CSF (>50 × 106/l)
Marked, persistent asymmetry of weakness
Bladder or bowel dysfunction at onset or
persistent during disease courseb Since the parents refuse lumbar puncture
Severe respiratory dysfunction with limited
limb weakness at onsetb , what else we can do ?
Sensory signs with limited weakness at onseta
Fever at onset
 Laboratory
investigation
complete blood counts and blood tests
for glucose, electrolytes, kidney
function and liver enzymes
to exclude other causes of acute flaccid
paralysis
Electrodiagnostic
studies
not required to diagnose GBS but
helpful in supporting the diagnosis
electrophysiological examination in
patients with GBS will reveal a
sensorimotor polyradiculoneuropathy
or polyneuropathy, indicated by reduced
conduction velocities, reduced sensory
and motor evoked amplitudes, abnormal
temporal dispersion and/or partial motor
conduction blocks
imaging
not part of the routine diagnostic
evaluation of GBS, but can be helpful
excluding differential diagnoses such
as brainstem infection, stroke, spinal
cord or anterior horn cell inflammation,
nerve root compression or
leptomeningeal malignancy
New potential diagnostic tool :
Ultrasound imaging of the peripheral
nerve - revealed enlarged cervical nerve
roots early in the disease course
Pathogenesis of
GBS
 1 Campylobacter jejuni
- diarrhea, abdominal
cramps
Cytomegalovirus
Epstein–Barr virus
Mycoplasma
pneumonia

Molecular mimicry:
2

AMAN: 4 AIDP:
3
(acute motor axonal (acute inflammatory demyelinating
neuropathy ) polyneuropathy )
-damage to motor neuron -damage to myelin shealth
-acute weakness of -acute weakness of limb,ribs,sensory
limbs,ribs sign (numbness ,tingling sensation)
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clinical features oculomotor weakness

of GBS
4

Weakness; starts in the leg

decreased/absent
1 and ascends usually. can 5
reflexes; arms or leg
begin in arms or face (10%)

Respiratory muscle
2 6 Parasthesias; hands or feet
weakness

Facial nerve
3 palsies/oropharyngeal
weakness
 Pain; due to nerve root
7 inflammation. back or
extremities

Disautonomia; life
8 threatening labile BP and
arrythmias

diarrhea/constipation,
hyponatremia, bradycardia,
sudden death
 Nerves that are
damaged in GBS

The myelin sheath that The nerves cannot

surrounds the axons of
many peripheral nerves
are damaged. The axons
itself can be damaged at
times
transmit signals
efficiently and the
muscles begin to lose
their ability to respond to
the brain's commands
 FEMORAL NERVE
Controls the major hip flexor
muscles, as well as knee
extension muscles. This nerve
will be affected by GBS
causing Hashim to require
assistance to raise his legs.
 OBTURATOR
NERVE
Functions to extend leg at knee
Damage of obturator nerve causes
weakness to leg and sensory loss.
Damage to this nerve causes weakness in
leg
 TIBIAL NERVE
Patient will suffer from
tingling, numbness and
weakness of knee if this nerve
is damaged


Phrenic nerve
Damage to phrenic
nerve causes diaphragm
weakness.
causes phrenic nerve
demyelination.

 Facial nerve

causes bilateral facial nerve palsy-

facial paralysis or paresis affection
both sides of the face, with onset being
either completely simultaneous or the
second side being affected within 30
days of the first side
 Procedure of
lumbar puncture
ANATOMY OF THE LUMBAR SPINE
?? What is lumbar puncture?

A lumbar puncture (spinal tap)

is a test used to diagnose
certain health conditions.
It's performed in your lower
back, in the lumbar region.
During a lumbar puncture, a
needle is inserted into the
space between two lumbar
bones (vertebrae) to remove a
sample of cerebrospinal fluid.
 Before the procedure

1. you lie on your side with your knees drawn up to your chest.

2. you sit and lean forward on a stable surface.

- These positions flex your back, widening the spaces between your
vertebrae and making it easier for your health care provider to
insert the needle.

3. Your back is washed with antiseptic soap or iodine and covered

with a sterile sheet.
 After the procedure
1. Plan to rest.

- Don't participate in strenuous activities the day of your

lumbar puncture (spinal tap).

- You may return to work if your job doesn't require you to be

physically active.

2. Take a pain medication.

- A nonprescription pain-relieving medication that contains

acetaminophen (Tylenol, others) can help reduce a headache or back pain.
Pathophysiology
of GBS
Causes of shortness of breath

Demyelination may ascends upwards

Involvement of peripheral nerve that supply the Respiratory muscle

Respiratory Failure

Breathlessness
Causes of acute dyspnea
Causes of chronic dyspnea
Causes of tingling and numbness

Demyelination of peripheral nerve

Nerve couldn’t transmit signal efficiently

Brain receives fewer sensory signals from the rest of the body;
Alternatively. Due to nerve injury, brain receives inappropriate
signal of tingling sensation and numbness
MERCI
 Medical issue Empathy
maybe he is the only child for
Guillain Barre Syndrome (GBS) them

MERCI
muscle numbness he is in the age of starting to
high-stepping gait be an independant child
have posssibilities to cause cannot be fully cured
paralysis he needs his parents help

Communication Respect & Rights

explain what is GBS clearly
they can reject the test
avoid use medical terms
(lumbar punture)
explain them all the
they can accept or reject the
procedures (treatment, test)
further treatment (choose
explain the side effects
traditional treatment)
(advantages & disadvantages)
 Insightful

financial issue
transportation or time issue
affects his daily life (studies,sports)
some will make fun of him
difficulties to work in the future
Thank You