1. This lecture was conducted during the Nephrology Unit Grand Ground by a Sub-intern under Nephrology Division, Department of Medicine in King Saud University. Nephrology Division is NOT responsible for the content of the presentation for it is intended for learning and /or education purpose only.

2. Done By: Sarah Bakhamis

3. What is GBS? serious disorder that occurs when the body's immune system mistakenly attacks part of the peripheral nervous system (myelin component). This leads to acute inflammatory demyelinating polyneuropathy.

4. Pathophysiology o Both cellular and humoral immune mechanisms appear to play a role. o Early inflammatory lesions consist of lymphocytic infiltrate o Macrophages are more prominent several days later.

6. Location It affects the nerve roots BILATERALY

7. Classification demyelinating polyneuropathy (AIDP) is the most common form of GBS. Miller Fisher syndrome (MFS) rare variant of GBS. It manifests as a descending paralysis, It usually affects the eye muscles first and presents with the triad of ophthalmoplegia, ataxia, and areflexia.

8. Classification Acute motor axonal neuropathy(AMAN) seen in china, present with weakness only. attacks motor nodes of Ranvier Acute motor sensory axonal neuropathy (AMSAN) affects sensory nerves with axonal damage. Regional variant. ( pharyngeal- cervical- bracheal weakness, or only leg weakness)

9. Triggers o It’s often follows a minor infection o Vaccination o Surgery o Bone marrow transplantation o Hodgkin's disease o Pregnancy

10. How To approach patient with GBS ?

11. History o Risk Factor. o Symptom: o Ascending weakness o Sensory impairment o Symmetrical involvement o Autonomic symptom o Pain o Progression/ Duration

12. Examination o Hypotonia. o Altered sensation or numbness. o Reduced or absent reflexes. o Facial weakness. o Autonomic dysfunction o Respiratory muscle paralysis.

13. Testing 1.Lumber Puncture (CSE Sample) Albumino-cytological dissociation. 2. Nerve function tests : a.Electromyography (EMG) b.Nerve conduction studies (NCS)

14. Testing EMG and NCS show: 1.Reduced conduction velocity 2.Conduction block 3.Prolonged distal latencies 4.Prolonged F-waves

15. Management  Aim: Lead to faster recovery relatively mild disability shorter hospital stay.

16. Mangement 1.Plasmapheresis consists of removing the liquid portion of your blood (plasma) and separating it from the actual blood cells. 2. Intravenous immunoglobulin Immunoglobulin contains healthy antibodies from blood donors.

17. Complication Breathing difficulties. Residual numbness or other sensations. Cardiovascular problems. Bowel and bladder function problems. Blood clots and Pressure sores. Increased risk of infections Sucking food or fluids into the lungs (aspiration)

18. Complication Relapse. Up to 10 to 20 percent of people with Guillain-Barre syndrome experience a relapse. Rarely, Death may occur from complications such as respiratory distress syndrome, heart attack and sepsis.

19. Prognosis With modern intensive care support, the outcome is excellent for most patients. Most people survive and recover completely. However about 20% of patients have residual disability, with weakness or persistent sensory disturbance. About 10% of patients die from respiratory failure, pulmonary emboli or infection.

20. Follow up Patient require several follow up visits to ensure that relapse do not occur and to help coordinate home-health services. Physical and occupaional therapy either in long term rehabilitation unit or at home.

21. Awareness When to see a doctor ? Call your doctor if you have mild tingling in your toes or fingers that doesn't seem to be spreading or getting worse.

22. Awareness When To Seek emergency medical help? Tingling that started in your feet or toes and is now ascending through your body Tingling or weakness that's spreading rapidly Tingling that involves both your hands and feet Difficulty catching your breath Choking on saliva

24. References Pupmed Health. Wikipedia Myoclinic