A Simple Guide to Guillain-Barre Syndrome

A Simple Guide to Guillain-Barre Syndrome
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What is Guillain-Barre Syndrome?
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Guillain-Barre Syndrome is a rare autoimmune progressive disease with relatively symmetrical weakness of 2 or more limbs due to neuropathy, areflexia and mild sensory symptoms of not more than 4 weeks duration.

The Guillain-Barre Syndrome is a condition also called acute inflammatory demyelinating polyneuropathy (AIDP).

What causes Guillain-Barre Syndrome?
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In Guillain-Barre Syndrome, antibodies produced by the body's immune system attacks the gangliosides of cranial, spinal and peripheral nerve usually after:

1.a nonspecific respiratory or gastrointestinal viral illness

2.infectious mononucleosis

3.Campylobacter jejuni , cytomegalovirus infection

4.vaccination

5.extreme exposure to cold

The result of the antibodies attack on the peripheral nerves is inflammation of myelin and blockage of nerve conduction, resulting in muscle paralysis with sensory or autonomic deficits.


Who is at risk of Guillain-Barre Syndrome?
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Guillain-Barre Syndrome occurs at any age usually at age 30-40.

It occurs more in men than in women.


What are the symptoms of Guillain-Barre Syndrome?
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The typical feature of Guillain-Barre Syndrome is

1.acute onset of symmetrical muscle weakness in both lower limbs with
ascending progression of the weakness upwards to the arms and face usually within hours or days.

2.the lower cranial nerves can also be affected leading to bulbar weakness, (dysphagia or difficulty with swallowing) and respiratory difficulties. If this happens , hospitalisation is a must.

3.Sensory loss is usually minor with loss of position, numbness or tingling sensation.

4.areflexia or complete loss of deep tendon reflexes is always present.

5.Loss of pain and temperature sensation may be present but mild.

6.pain is a common symptom with deep aching pain usually in the weakened muscles.

7.Autonomic dysfunction such as tachycardia, diarrhea, bladder dysfunction may occur but are usually transient.

8.absence of fever is one of the sign of Guillian Barre Syndrome.
If there is fever, another cause should be suspected.

Recovery usually begins 2-4 weeks after progression of disease stops.

How is the diagnosis of Guillain-Barre Syndrome made?
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The diagnosis of Guillain-Barre Syndrome involve

1.History of a rapid onset and progression of ascending motor weakness, areflexia and the absence of fever.

2.physical and neurological examinations for peripheral neurological deficit.

3.cerebrospinal fluid examination-
typical CSF findings show albumino-cytological dissociation,

a. an elevated protein level (100 - 1000 mg/dL)
b. absent pleocytosis (increased cell count)unlike infectious causes.

4.Electromyographic studies and nerve conduction studies may show prolonged distal latencies, conduction slowing, nerve conduction blockage suggestive of demyelination.

5.Computed tomography or MRI may show actual demyelination of the nerve.

What are the complications for Guillain-Barre Syndrome ?
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1.Progression of nerve involvement to whole body

2.Paralysis of respiratory muscles and swallowing can be life threatening

What is the treatment for Guillain-Barre Syndrome ?
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Treatment for Guillain-Barre Syndrome may be urgent especially in cases of respiratory distress:

1.Hospitalisation and early intubation with a respirator on standby in case of difficulty in respiration

2.treatment of the underlying cause is started as soon as possible:

a. High dose intravenous immune globulin, which temporarily modifies the immune system and provides the body with normal antibodies from donated blood or

b.plasmapheresis in which abnormal antibodies are removed from the blood.

3.rehabilitation is atrted after the patient is stable and will focus on improving activities of daily living functions such as brushing teeth, washing and getting dressed.

4.physiotherapy to strengthen muscles

5.Speech therapy for speech and awallowing

6. Corticosteroids have no part to play in the treatment of Guillian Barre Syndrome.


What is the prognosis of Guillian-Barre Syndrome?
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1.With all these new treatments the prognosis for most patients with Guillain-Barre Syndrome is good with 80% recovery within 1 year

2.Some of them may have persistant minor neurological deficits such as areflexia.

3.Some 5% recover but with severe disability involving severe proximal motor and sensory axonal damage with inability of axonal regeneration.

4.About 10% of patients have relapses and are as classified as having chronic inflammatory demyelinating polyneuropathy

5.Death is rare(5%) and may be due to severe paralysis, autonomic dysfunction and other severe pulmonary complications.

A Simple Guide to Stroke

A Simple Guide to Stroke
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What is a Stroke?
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A stroke is also known as a cerebrovascular accident(CVA).
It happens when the blood vessel to a part of the brain is blocked(due to a blood clot) or burst.
The brain cells in that part cannot get the oxygen and nutrients so they are damaged and unable to function.

What Causes Stroke?
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A stroke occurs when:

1.there is a blockage of an artery in the brain by a blood clot, piece of fat or air bubble travelling in the blood from another part of the body.
This leads to lack of supply of oxygen and nutrients to the brain cells.
As a result the brain cells died leading to loss of function of the part of the body controlled by the brain cells.

2.there is a rupture of an artery in the brain leading to internal bleeding and damage to the brain cells.
This can be caused by high blood pressure, head injury or a weak artery wall from birth(aneurym).

3.there is compression by a brain tumour or tightening of the artery wall.

What are the risk factors in Stroke:
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1.High Blood pressure-
Hypertension damages the arteries of the brain by causing bleeding or blockage

2.High cholesterol-
Cholesterol deposit thickens the walls of the arteries, making them narrow and reducing blood flow.

3.Diabetes mellitus
The high blood sugar level thickens the arteries hard and make the blood thick so that less blood is able to flow through them.

4.Heart disease
People with heart disease are more likely to have poor blood flow to the brain.
Some heart disease like atrial fibrillation can throw out blood clots which can block the blood supply of the brain

5.Obesity
A BMI of 23.0kg/m² and above increases the risk of getting high blood pressure, diabetes and stroke.
6.Smoking
Tobacco smoke narrows arteries and reduces oxygen supply to the brain.

7.Drinking of Alcohol
Alcohol can cause liver and kidney damage. increase blood pressure and affect diabetes

8.Cerebral aneurysm, tumour,cancer metastasis,
These can cause blockage and bleeding in the arteries of the brain

9.Trauma or surgery of the brain
These can cause bleeding or form blood clots in the arteries of the brain

10.Stress
Repeated stress, if poorly controlled, can lead to high blood pressure.

What is a temporary Stroke or Transient ischaemic attack(TIA)?
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It is a early warning sign of a stroke .
TIA occurs when blood supply to a part of the brain is temporarily cut off causing slight damage to the brain cell.

It may last seconds to up to 24 hours.

The symptoms of a TIA are often vague and temporary:

1.temporary numbness or weakness occurring suddenly in one arm or leg or on one side of the face

2.temporary difficulty in speaking or slurring of speech

3.sudden difficulty in seeing or 'blackout' in one eye

4.temporary dizziness or fainting or loss of balance

5.Temporary confusion, poor coordination or understanding

6.unexplained headaches or a change in the usual headache pattern

Early treatment of a TIA can help prevent a stroke from occurring in the future.

What are the symptoms and signs of a Stroke?
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The affected person may have:

1.sudden numbness or weakness, usually on one side of the body,often with loss of feeling

2.difficulty in speaking or understanding

3.difficulty in swallowing

4.loss of concentration and memory

5.sudden difficulty walking

6.loss of control of passing urine or passing motion

7.behaviour changes such as laughing or crying at the wrong time, feeling depressed or showing bad temper.

8.sudden severe giddiness, loss of balance and coordination

9.sudden severe headache with no known cause

10.sudden vision loss in one eye

Treatment and caring for stroke patient will be in the Simple Guide to Stroke 2.