Guillain-Barre Syndrome (GBS)

1. What is the etiology of Guillain-Barre Syndrome (acute inflammatory demyelinating polyradiculopathy)?
2. What is the clinical presentation of GBS?
3. What is seen in the CSF?
4. What are the findings on EMG? What EMG findings are associated with a poorer prognosis?
5. What is the treatment?

Answers:
1. Post-viral autoimmune attack on myelin and Schwann cells that generally occurs 1-4 weeks post illness, vaccination, or surgery.
2. Ascending symmetry weakness and sensory abnormalities, areflexia, possible respiratory and autonomic failure, possible CN involvement (usually VII).
3. Increased protein, few mononuclear cells, called albumino-cytologic dissociation.
4. NCS shows abnormal SNAP, CMAP abnormal with increased temporal dispersion. F wave abnormal early in the disease. EMG is normal. Poor prognosis is associated with CMAP amp <20% normal, CV <40% normal, absent F waves, abnormal EMG.
5. Rehabilitation, plasmapheresis, IVIG, respiratory support Steroids have been found to be ineffective.