1. Neurology Chapter of IAP Guillain-Barre’

2. Neurology Chapter of IAP Guillain-Barre’ Syndrome Post-infectious polyneuropathy; ascending polyneuropathic paralysis An acute, rapidly progressing and potentially fatal form of polyneuritis

3. Neurology Chapter of IAP Guillain-Barre’ Syndrome Affects the peripheral nervous system

4. Neurology Chapter of IAP

5. Guillain-Barre’ T-cell sensitization occurs which causes loss of myelin which disrupts nerve impulses Loss of myelin, edema and inflammation of the affected nerves, causes a loss of neurotransmission to the periphery. 85% of patients recover with supportive care.

6. Neurology Chapter of IAP Pathophysiology Etiology unknown May be cell-mediated immunological reaction directed at the peripheral nerves Frequently preceded by viral infection, trauma, surgery or other immune system stimulation.

7. Neurology Chapter of IAP Myelin Sheath

8. Neurology Chapter of IAP Clinical Manifestations Usually develop 1 to 3 weeks after URI or GI infection Weakness of lower extremities (symmetrically) Parathesia (numbness and tingling), followed by paralysis Hypotonia and areflexia (absence of reflexes) Pain in the form of muscles cramps or hyperesthesias (worse at night).

9. Neurology Chapter of IAP Clinical manifestations Autonomic nervous system dysfunction results from alterations in sympathetic and parasympathetic nervous systems. Results in respiratory muscle paralysis, hypotension, hypertension, bradycardia, heart block, asystole. Involvement of lower brainstem leads to facial and eye weakness

10. Neurology Chapter of IAP Complications Most serious is respiratory failure. How do we manage?

11. Neurology Chapter of IAP Diagnostic studies Based on history and physical EMG and nerve conduction studies will be abnormal

12. Neurology Chapter of IAP Therapeutic management Ventilator support! Plasmapheresis used within the first 2 weeks of onset. If treated within the first 2 weeks, LOS of morbidity is reduced. After three weeks, plasmapharesis no benefit. IV immunoglobin Nutritional support (TF, TPN, Diet)

13. Neurology Chapter of IAP Nursing management See handout! Read Nursing Implementation: Lewis, 1607-1608.