A case study of GBS
Name- Hamza ABDEEN
Year / semester - 4th/8th
Enrolment no - 2000100380
Group -A
Contents
● Introduction
●
● Incidence
●
● Causes
●
● Types
●
● Assessment
●
● Management
Introduction
The demyelination from of Guillan Barre Syndrome destroys the protective
coverings of the Peripheral nerve ( myelin sheath)
Preventing the nerve from transferring singnals the brain.
Incidence
● The annual Incidence of gbs range from 0.5-1.5 cases per 100,000
populations in the individual young than 18 year.
●
● No evidence exist for any Acial predilection
●
● Male appear to be at greater risk for gbs the females
Cause
The exact cases Guillan Barre Syndrome isn’t known.
The disorder usually appears days or weeks after a respiratory or digestive
tract infection.
There have been cases reported following infection with the Zika virus.
Guillain-Barre syndrome may occur after infection with the COVID-19 virus. It's
also a rare reaction in those who receive the Johnson & Johnson or
AstraZeneca COVID-19 vaccine.
● Influenza virus
● Cytomegalovirus
● Epstein Barr virus
● HIV the virus can AIDS
● Hodgkin ,lymphoma
Types
The main type
AIDP ( Acute inflammatory demyelinating polyradiculoneuropathy). the most
common form in North America and Europe. The most common sign of AIDP
is muscle weakness that starts in the lower part of your body and spreads
upward.
Miller Fisher syndrome (MFS), in which paralysis starts in the eyes. MFS is
also associated with unsteady gait. MFS is less common in the U.S. but more
common in Asia.
Acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal
neuropathy (AMSAN) are less common in the U.S. But AMAN and AMSAN
are more frequent in China, Japan and Mexico.
Assessment
Apart from demographic data, complaints and history, the following assessment
are essential in polyneuropathy
Demographic data
Name - xyz
Age - Common as all age affects
Sex - Common in female
Occupation -
Chief Complaint
1. Weakness or paralysis starting in the legs and often spreading to the arms and
upper body.
2. Tingling or numbness in the extremities (hands and feet).
3. Difficulty with coordination and balance.
4. Pain or aching in muscles, particularly during movement.
5. Difficulty breathing or swallowing in severe cases.
6. Fatigue and generalized weakness.
History of present illness
Patients with Guillain-Barré syndrome (GBS) present with complaints of weakness
and/or unsteadiness (ataxia). Weakness is a hallmark of GBS. The weakness typically
starts in the legs and ascends to the arms (hence, the description progressive ascending
flaccid paralysis). This progression may occur over hours to days to weeks. The
weakness is usually symmetric.
Past History - HTN, FEVER ,DM
Medical History - No
Family history - Not relevant
Socio-economic status - Low / Middle / High
Observation
The attitude of limbs, wasting of the muscles, deformity and tropic changes
involving the skin, should be observed.
In case the patient is on a ventilatory assistance, as in cases of acute cases of
Guillain barre syndrome, the setting of the ventilator, vital parameter
displayed on the pulse oximeter, etc. should be recorded.
Examinations
Cranial Nerve Testing
Sensory Examination
ROM Testing: Both active a passive ROM should be tested, tightness or
contracture should be identified.
Manual Muscle Testing (MMT)
The muscle should be graded from 1 to 5. Individual muscle testing is
a must as it gives an idea about the extent and distribution of
weakness thus giving an indication about the various nerves involved.
Reflexes
Deep tendon and superficial reflexes should be
checked
Functional assessment-
The patient should be assessed for all the activities
of daily living to find the level of independency of
the patient. It is noted that based on the distribution
of the weakness
Investigation
CSF protein is
1. Elevated in most patients after 2nd or 3rd week of
illness
2. Cells are usually absent (80%)
NCV studies shows:
1. Slowed MNCV
2. Conduction block
3. Prolonged distal motor latency
Other investigations: Vaccination
1. Viral or bacterial studies
Rabies, typhoid, tetanus, or
2. Electrolytes are checked influenza vaccination may
precipitate
the attack of GBS.
Surgery
After 4 to 5 weeks of major surgery patient may
show signs of GBS which can be attributed to the
following reasons:
• release of neural antigen that provokes
Infection autoimmune response
Viral in the form of • due to surgical stress
• because of blood transfusion.
Epstein Barr virus,
bacterial in the form of
mycoplasma pneumonia.
Medical Management
• Plasmapheresis
• Steroid therapy
• Injection of IgG (Immunoglobulin-G)
PT MANAGEMENT IN GBS
1.
CAUSES FOR DISABILTIY IN GBS
Primary cause
Muscle weakness Loss or impairment of sensory input from joints, muscles, spine, skin
Pain
Respiratory insufficiency
2. Secondary cause :
Disease and neurogenic wasting
Muscle fatigue
Cardio - respiratory deconditioning
Contractures Poor sleep
confusion
AIMS OF PT MANAGEMENT
1. Maintain clear airways
2. Prevent lungs infections
3. Maintain ROM 4. Support joints in a functional position to minimize
damage or deformity
5. Assist in prevention of pressure sores
6. Maintain peripheral circulation
7. Provide
References
Slide share
Book physiotherapy neuro condition
YouTube
Neuro paediatric research paper
Website medscape.com
http://www.mayoclinic.org
