NI GUILLAIN
GROUP 1
BEST SELLER!!!
CHAVEZ, DANIELLE KAYE- SILOG
CREMAN, MARIELLE- SILOG
DEBALUCOS, HAZEL- SILOG
CASE STUDY P69.00
A case of a 33-year old teacher rushed to the ER after fainting in the
middle of a class discussion. Prior to syncope, patient remembered
persistent finger dysesthesia described as painful “pins-and-needles”
sensation, proximal weakness with numbness of the lower extremities,
and shortness of breath. She had difficulty walking steadily and
eventually lost her coordination.
12 hours after admission, weakness progressed to upper extremities.
NSAIDs were administered but were ineffective.
24 hours post-admission, patient’s face showed drooping with
inability to close eyes and mouth. Saliva pooled in the mouth and
speech was slurred but without dysphagia. She felt nauseous and
started vomiting.
A further 24 hours later, she developed lethargy, bilateral facial pains,
loss of limbic control and reportedly wet her bed. Few hours more,
the loss of limbic control progressed to paraplegia and breathing has
become too labored, warranting a respirator.
HISTORY OF PRESENT ILLNESS P71.50
Patient was previously in good health with an exception of a 3-day admission three
weeks earlier. She was diagnosed with self-limiting diarrhea caused by
Campylobacter jejuni infection after eating excessive undercooked roasted chicken.
Symptoms resolved spontaneously.
Two weeks after discharge, she started feeling crawling sensations from her hands
and toes accompanied by muscular weakness. She consulted the school physician,
who dismissed it as fatigue and stress. Patient has no history of substance abuse,
alcoholism, smoking and maintenance drugs.
LABORATORY FINDINGS
CBC and urine studies are normal
ESR 71 mm/hr
IMMUNOLOGIC STUDIES
BLOOD CHEMISTRY
RF: NEGATIVE
FBS 108 mg/dL ANA: NEGATIVE
HETEROPHILE NEGATIVE
CPK 1,700 IU/L AGGLUTINATIO
N:
Serum electrolytes show slight
ANTI-GANGLIO (+) FOR anti-GM1 ANTIBODIES
hyponatremia and hyperkalemia.
SIDE Ab (AGA):
Heavy Metals Screens are
unremarkable.
CEREBROSPINAL FLUID WORKUP OTHER TESTS
COLOR COLORLESS NERVE SLOWED
NERVE
APPEARANCE CLEAR
CONDUCTION STUDIES CONDUCTION
CELL COUNT 5 wbcs/mm3 LATENCIES
WITH
PROLONGED F
GLUCOSE 75 mg/dl WAVES
PROTEIN 450 mg/dl
ELECTROMYOGRAPHY moderate decrease
CSF PROTEIN OLIGOCLONAL in recruitment,
ELECTROPHORESIS BANDING suggestive of
polyneuropathy of
GRAM STAIN NO relatively acute
MICROORGANISM onset
SEEN
PHYSICAL EXAMINATION P50.00
Patient was afebrile upon admission. There was diffuse weakness of all four
extremities. Muscle stretch reflexes were absent, mainly the patellar-jerk
reflex. Abdomen revealed paucity of bowel sounds. Suprapubic tenderness
is also noted.
Latest vital signs include: Temperature 37.7°C, pulse of 116 bpm and
respiration of 27 breaths per min. Since admission, blood pressure has
been fluctuating, exhibiting paroxysmal hypertension and orthostatic
hypotension.
PATIENT ASSESSMENT P73.25
NAME: (X)
AGE: 33 years old
SEX: Female
PROFESSION: Teacher
CHIEF COMPLAINTS
- Finger dysesthesia
- proximal weakness with numbness of the lower extremities
- shortness of breath
- difficulty walking steadily
SIGNS & SYMPTOMS P15.00
➢ finger dysesthesia
➢ proximal weakness with numbness of the lower extremities
➢ shortness of breath
➢ Difficulty in walking steadily and lost of coordination
12 hours after admission
➢ Weakness progressed to upper extremities
24 hours post-admission
➢ Drooping of face and inability to close eyes and mouth
➢ Slurred speech without dysphagia
➢ Nauseous
24 hours further
➢ Lethargy, bilateral facial pains, loss of limbic control and inability to control urinating
➢ Difficulty in breathing
DEFINITION OF RELEVANT TERMS P17.50
Dysesthesia - abnormal sensation typically tingling or pricking (“pins and needles”),
Patellar-jerk reflex - is a simple reflex that causes the contraction of the quadriceps muscle when the patellar tendon
is stretched
Demyelination - occurs when myelin, which is the protective coating of nerve cells, sustains damage
Autoimmune - A condition in which the body's immune system mistakes its own healthy tissues as foreign and attacks
them
Peripheral nerve system - consists of the nerves that branch out from the brain and spinal cord
Anti-Ganglioside Ab (AGA) - that react to self-gangliosides are found in autoimmune neuropathies.
Molecular mimicry - similarities between foreign and self-peptides favor an activation of autoreactive T or B cells by a
foreign-derived antigen in a susceptible individual.
Gangliosides - play important roles in the modulation of membrane proteins and ion channels, in cell signaling and in
the communication among cells.
Areflexia - absence of deep tendon reflex; a condition in which your muscles don’t respond to stimuli.
INTERPRETATION OF LABORATORY RESULTS
BLOOD CHEMISTRY
TEST RESULT REFERENCE INTERPRETATIO
RANGE N
FBS 108 mg/dL 70–105 mg/dL NORMAL
CPK 1700 IU/L 21 to 215 IU/L ABOVE NORMAL
ESR 71 mm/hr <20mm/h ABOVE
NORMAL
CEREBROSPINAL FLUID WORKUP
TEST RESULT REFERENCE INTERPRETATION
RANGE
COLOR Colorless COLORLESS NORMAL
APPEARANCE Clear Clear NORMAL
CELL COUNT 5 wbcs/mm3 0–5 lymphocytes/mcL NORMAL
GLUCOSE 75 mg/dL 40–80 mg/dL NORMAL
PROTEIN 450 mg/dL 15–60 mg/dL ABOVE NORMAL
GRAM STAIN No microorganism No microorganism NORMAL
seen seen
IMMUNOLOGIC STUDIES
TEST RESULT REFERENCE INTERPRETATION
RANGE
RF NEGATIVE NEGATIVE NORMAL
ANA-HETEROPHILE NEGATIVE NEGATIVE NORMAL
AGGLUTINATION
AGA (+) for anti-GM1 (-) ABOVE NORMAL
antibodies
DIFFERENTIAL DIAGNOSIS
GUILLAIN-BARRE GUILLAIN-BARRE GUILLAIN-BARRE
SIGNS &
SYNDROME - ACUTE SYNDROME - ACUTE SYNDROME-ACUTE MYASTHENIA MILLER FISHER BOTULISM
SYMPTOMS INFLAMMATORY
MOTOR AND SENSORY
AXONAL NEUROPATHY
MOTOR AXONAL
NEUROPATHY
DEMYELINATING GRAVIS SYNDROME
POLYNEUROPATHY
Finger Dysesthesia
Symmetrical ascending
weakness
Shortness of Breath
Difficulty in Walking
Drooping of face &
ability to close eyes &
mouth
Slurred speech w/o
Dysphagia
Nausea & Vomiting
Lethargy
Loss of muscle
stretch Reflex
LABORA LABO- GUILLAIN- GUILLAIN- GUILLAIN- MYASTHENIA MILLER BOTULISM
TORY RATORY BARRE BARRE BARRE GRAVIS FISHER
SYNDROME - SYNDROME SYNDROME SYNDROME
RESULT RESULTS AMSAN - AMAN - AIDP
FBS 108 mg/dL NORMAL -
CPK 1,700 IU/L
RF NEGATIVE NEGATIVE NEGATIVE NEGATIVE NEGATIVE POSITIVE NEGATIVE NEGATIVE
ANA-HETERO- NEGATIVE NEGATIVE NEGATIVE NEGATIVE NEGATIVE POSITIVE NEGATIVE NEGATIVE
PHILE
AGGLUTINATI
ON
AGA (+) for
(Anti-Gang anti-GM1 NEGATIVE NEGATIVE
lioside Ab) antiobodies
LAB INTERPRETATION GUILLAIN- GUILLAIN- GUILLAIN- MYAS- MILLER BOTULISM
PARAMETERS BARRE BARRE BARRE THENIA FISHER
RESULTS SYNDROME - SYNDROME - SYNDROME - GRAVIS SYNDROME
AMSAN AMAN AIDP
CSF Color Colorless Normal NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL
Appearance Clear Normal NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL
Cell Count 5 Normal NORMAL NORMAL NORMAL NORMAL NORMAL
WBCs/mm3
Glucose 75 mg/dL Normal NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL
Protein 450 mg/dL NORMAL
GRAM No No No No Gram No Gram
STAIN microorganis microorga microorga microorg positive microorga positive
m seen bacteria
nism nism seen anism bacteria nism
seen seen seen
FINAL DIAGNOSIS
GUILLAIN-BARRE SYNDROME
(Acute inflammatory demyelinating
polyradiculoneuropathy)
WHAT IS GUILLAIN-BARRE SYNDROME?
➔ Is a rare, autoimmune disorder in which a person’s own immune system damages the
nerves, causing muscle weakness & sometimes paralysis. And a post-infectious
neuropathy and known to be triggered by certain infections like Campylobacter jejuni.
➔ It is characterized by rapidly progressive, symmetrical limb weakness with hypoflexia
or araflexia.
➔ Symptoms of GBS last for a few weeks to several years.
TYPES OF GUILLAIN- BARRE SYNDROME
Once thought to be a single disorder, Guillain-Barre syndrome is now known to occur in several forms. The main types are:
● Acute inflammatory demyelinating polyradiculoneuropathy (AIDP)
➔ the most common form in North America and Europe.
➔ It is an autoimmune processed in which it predominantly affects the myelin
and it is characterized by progressive areflexic weakness and mild sensory
weakness.
● Miller Fisher Syndrome (MFS)
➔ MFS is less common in the U.S. but more common in Asia.
➔ A rare acquired nerve disease.
➔ Its features include weakness of the eye muscles causing difficulty moving
the eyes, impaired limb coordination & unsteadiness, and absent tendon
reflexes.
➔ Ophthalmoplegia, Ataxia and Areflexia
● Acute Motor Axonal Neuropathy (AMAN)
➔ More frequent in China, Japan and Mexico
➔ A variant type of GBS
➔ A non-inflammatory disease whereby axons of motor nerve cells are selectively
targeted and destroyed by the body’s own immune system
● Acute Motor-Sensory Axonal Neuropathy (AMSAN)
➔ A rare & severe variant of GBS that has prolonged recovery course.
➔ Less common in the U.S and are more frequent in China, Japan and Mexico
➔ It is a severe acute illness and are often presents as rapid and severe motor and
sensory dysfunction.
➔ Often associated with preceding C. jejuni diarrhea and show severe axonal
degeneration of motor and sensory nerve fibers with little demyelination.
CAMPYLOBACTER JEJUNI
Phylum: Campylobacterota
Family: Campylobacteraceae
Order: Campylobacterales
★ It is the most common cause of bacterial gastroenteritis worldwide
★ It is a slow growing, fastidious and asaccharolytic; it has a darting motility; and
unable to grow in 3.5% NaCl
★ It is acquired from eating contaminated chicken and turkey (does not mutply in food)
★ It invades the epithelium of the small intestine, causing inflammation
★ It also secretes a toxin that is antigenically similar to the cholera toxin.
★ OPTIMUM GROWTH: 42C
★ MICROSCOPY: Curved or Seagull-winged shaped
★ INFECTIVE DOSE: More than or equal to 10,000 Organisms
RISK FACTORS P33.25
● Most commonly, ● Mycoplasma pneumonia
● Epstein-Barr virus
infection with ● Surgery
● Zika virus
campylobacter, a ● Trauma
● Hepatitis A, B, C and
type of bacteria ● Hodgkin's lymphoma
E
● COVID-19 virus
often found in ● HIV, the virus that
● COVID-19 Johnson &
undercooked poultry causes AIDS
Johnson vaccine
● Influenza virus
● Cytomegalovirus
EPIDEMIOLOGY P55.35
➔ It occurs throughout the world with a median annual incidence of 1.3 cases per population of 100,000 with men being
more frequently affected than women.
PATHOPHYSIOLOGY P72.25
PNEUMONIA
PRESSURE SORES
SEPSIS
COMPLICATIONS
GASTRITIS
OF
GBS
PULMONARY EMBOLUS
CONSTIPATION
Brighton Criteria for Guillain Barre Syndrome
EXAMINATIONS P12.25
● Spinal tap (lumbar puncture). A small amount of fluid is withdrawn from
the spinal canal in your lower back. The fluid is tested for a type of change
that commonly occurs in people who have Guillain-Barre syndrome.
● Electromyography. Thin-needle electrodes are inserted into the muscles
your doctor wants to study. The electrodes measure nerve activity in the
muscles.
● Nerve conduction studies. Electrodes are taped to the skin above your
nerves. A small shock is passed through the nerve to measure the speed
of nerve signals.
TREATMENT P21.50
● NO KNOWN CURE
IMMUNOMODULATORY THERAPY P30.00
EXTRAS:
● Plasmapheresis P15.00
● Intravenous Immunoglobulins (IVIGs) P15.00
SUPPORTIVE CARE FREE
LOW MOLECULAR WEIGHT HEPARIN P90.00
ANALGESICS P10.00
TRICYCLIC ANTIDEPRESSANTS P100.00
ANTICONVULSANTS P250.00
IMMUNOMODULATORY THERAPY P63.35
PLASMAPHERESIS
❏ removes antibodies and other potentially injurious factors from the bloodstream. The
liquid portion of part of your blood (plasma) is removed and separated from your blood cells.
The blood cells are then put back into your body, which manufactures more plasma to make
up for what was removed. Plasmapheresis may work by ridding plasma of certain antibodies
that contribute to the immune system's attack on the peripheral nerves.
INTRAVENOUS IMMUNOGLOBULINS
❏ Immunoglobulin containing healthy antibodies from blood donors is given through a vein
(intravenously). High doses of immunoglobulin can block the damaging antibodies that may
contribute to Guillain-Barre syndrome.
SUPPORTIVE CARE P72.50
PHYSICAL HELP AND THERAPY BEFORE AND DURING RECOVERY
● Movement of your arms and legs by caregivers before recovery, to help keep
your muscles flexible and strong
● Physical therapy during recovery to help you cope with fatigue and regain
strength and proper movement
● Training with adaptive devices, such as a wheelchair or braces, to give you
mobility and self-care skills
BESTSELLER!!!
P179.59 ONLY
PREVENTION
There is no known action that
can be taken to prevent
Guillain-Barre syndrome.
MANAGEMENT P42.50
Call your doctor if you have mild tingling in your toes or fingers that doesn't seem to be
spreading or getting worse. Seek emergency medical help if you have any of these severe
signs or symptoms:
● Tingling that started in your feet or toes and is now moving up your body
● Tingling or weakness that's spreading rapidly
● Difficulty catching your breath or shortness of breath when lying flat
● Choking on saliva
REFERENCE P63.50
● https://about-guillain-barre.com/about-guillain-barre-syndrome
● https://www.mayoclinic.org/diseases-conditions/guillain-barre-syndrome/symp
toms-causes/syc-20362793
● https://www.osmosis.org/learn/Campylobacter_jejuni
● https://www.msdmanuals.com/professional/resources/normal-laboratory-value
s/cerebrospinal-fluid-csf-tests-normal-values
● https://www.msdmanuals.com/professional/resources/normal-laboratory-value
s/blood-tests-normal-values
