Guillain-Barré Syndrome (GBS): causes, symptoms, diagnosis,and treatment

Guillain-Barré Syndrome (GBS)


WHAT'S HAPPENING?

Guillain-Barré Syndrome (GBS) is a debilitating disease of the peripheral nervous system (PNS). It is an autoimmune type II hypersensitivity disorder. The most common type of GBS is a severe inflammatory reversal of polyradiculopathy which is an autoimmune disease that destroys Schwann cells. This is a strange situation, but we must understand it

The main cause of GBS is disconnection of source sensors (source)

The main cause of GBS is a blood clot in the arteries (source)

WHAT CAUSES?

It is believed that this immune system is caused by infections that lead to an attack of the peripheral myelin (due to cellular mimicry, inoculation, and stress). While there is no clear link at this time, the onset of GBS is often associated with recent infections. The most common infection before GBS is diarrhea caused by Campylobacter june.

While it never seems to be the cause, GBS usually occurs after a recent infection. The most common of these infections are GI and the pathogen Campylobacter jejuni (source)


WHY IS IT A PROBLEM?

Schwann cells are responsible for the PNS axons, and their destruction will lead to the removal of these axons. This will also slow down / stop the activation of the nerves (given the role of myelin in reducing energy / promoting the activation of the nerve endings). Eventually patients will experience motor weakness and loss of sensation at their edges.

Loss of myelin sheath around the axons of the nerves will reduce the speed at which the signals travel through the axon (source)

Loss of myelin sheath around the axons of the nerves will reduce the speed at which the signals travel through the axon (source)


WHAT MAKES US DOUBT?

Risk factors:

Recent infections (Campylobacter jejuni, CMV, EBV, etc.) often GI / respiratory system

First presentation:

Key Complaints:

  1. Putting on the hands / feet can be one of the first signs.
  2. Facial weakness: this is a very common problem in many patients.
  3. Muscle weakness: usually affects the distal muscles first
  4. Malnutrition is a common complaint that often develops over time.

Current Sick History:

Past history of infection is common (as described above).

The onset of symptoms will be severe: symptoms develop / persist in days to weeks. This is very different and can help increase suspicion of GBS.

Motor impairments tend to be more environmentally friendly, and escalate further (lower extremity edges are affected first). This is due to the very long axons not limited to the lower extremities which are more sensitive to myelin loss (given the length at which nerve pressure should fall).

Pain can usually be felt by the patient in areas where weakness / nerves change.

Symptoms of the bladder are usually not present at the onset of symptoms (but may develop over time).

Patients with GBS often have an ascending pattern of symptoms that begin in the lower extremities, and progress to the body.

Patients with GBS often have an ascending pattern of symptoms that begin in the lower extremities, and progress to the body.


Physical Examination:

  1. Vital symptoms may indicate signs of autism which can include:
  2. Heart failure such as bradycardia
  3. Changes in blood pressure such as hypertension or postural hypotension


The HEENT test may show:

Facial deformities most commonly found in patients.

Additional muscle paralysis is present (but rarely when facial paralysis)

Respiratory tests may show shallow breathing. This can be caused by transient weakness and is a bad sign.

Vehicle tests may show:

Muscle weakness that is usually balanced and elevated in nature

The severity of the weakness varies depending on the condition of the condition.

Visual testing can also show changed hearing patterns. It is important to know that nerve and motor fibers tend to travel together (share myelin sheaths as they can contribute to the formation of a particular nerve). This explains why both sensory processes can be affected in degenerative conditions such as GBS.

Reflex tests will often show a decrease in symptoms (one of the early clinical findings of GBS) due to arc reflex disruption. Depending on the situation the ankles and patellar reflexes will usually decrease first.

Given the reliability of the arc reflex in both the roundabout and vehicle modes, conditions such as GBS tend to be mind-boggling (source)

Given the reliability of the arc reflex in both the roundabout and vehicle modes, conditions such as GBS tend to be mind-boggling (source)


Fundoscopy can sometimes reveal papilledema in patients. The pathogenesis if not fully understood, but GBS in some cases can increase the pressure of dysfunction in patients. This is a fact perhaps best studied in limited trials by competing and performing clinics.

HOW DO WE PERFORM A PERFECT HEALTH WORK?

Based on a history / suspicious clinical trial with GBS there are a few other studies that can be done that can help confirm a suspected diagnosis of GBS.

Lumber puncture and CSF analysis: CSF testing can help further support GBS diagnosis. It is important to note that the initial study of lumbar puncture may be within the range of reference, and a retrospective study may be required to evaluate the findings below.

Xanthochromic (yellow) production of CSF due to high protein levels.

Increased protein (can be up to 1 gram in some cases)

Normal white cell count (albuminocytologic classification)

All other prices are usually in the reference range: there should be no CSF ​​infection if this is just GBS.

Emotional / EMG studies will show long-term distal delay and / or delayed nerve conduction in the affected arteries.

Nerve biopsy (rarely shown): if this study was performed, it could provide histological evidence of myelin damage.


What else are we worried about?



Respiratory failure due to depletion of nerve impulses: similar to other processes in the body, breathing requires emotional control (e.g., as GBS progresses, respiratory control nerves may be involved, leading to potentially dangerous respiratory problems. Pulmonary function tests can be used to assess a patient's final function.

Mechanical ventilation may be required in some cases of GBS. Respiratory failure is a serous problem of the condition (source)

HOW DO WE MANAGE IT?

Treatment for GBS includes a few things that address the etiology and side effects of the disease:

Respiratory support is provided to patients to protect their oxygen potential in their body (patients can be intubated if a necessary)

Pain can be controlled with medications such as Gabapentin.

Immunotherapy is given to identify the basic etiology of this condition. Removal / inactivation of anti-myelin anti-inflammatory antibodies is the purpose of this treatment.

IVIG is used to reduce auto-antibodies in the blood. This treatment is often recommended for more serious cases (where patients can be independent but do not need intubation)


Plasma exchanges are used to remove auto-antibodies from patients' blood. This treatment is often recommended for serious cases (when patients require mechanical ventilation.

HOW DID PATIENTS WORK?

This is not a chronic condition: most patients undergoing treatment will recover and recover in a few weeks / months.






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