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39 Cards in this Set
- Front
- Back
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What type of disease is GBS
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Aute demyelingating inflammatory polyradiculoneuropathy (PNS)
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How is GBS inflammatory?
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Due to autoimmune attack... macrophages attack spinal roots and peripheral nerves = strip myelin sheaths
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Precursor to s/s of GBS?
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2/3 of ppl had an infection 2 weeks prior to onset of symptoms
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Possible causes of GBS? Molecular Mimicry
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Infections - virus or bacteria
immunizations possible (Swine flu in 76) Environmental (chicken shit in china) |
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Why is GBS considered a syndrome and not a disease?
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B/c it is characterized by a series of signs and symptoms - not an actual disease process
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Two targets of GBS...which one sucks more?
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Myelin
Axon - related to longer lasting or permanent losses |
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2 types of polyneuropathies
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GBS
Charcot-Marie-Tooth dx |
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What is Charcot-Maries-Tooth dx
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Attacks peripheral myelin and/or axons in longest axons (hands and feet)
High arch with clot toes Very slow, progressive Begins in adolscents/young adults |
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What is myathenia gravis?
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Autoimmune disorder which causes antibodies to block ACh receptors and NMJ
Fatigue easily, better with rest |
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AIDP
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Acute inflammatory demyelinating polyneurophathy
Attacks motor and sensory myelin |
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AMAN
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Acute motor axonal neuropathy
Preferentially attacks motor AXONs and leaves myelin intact |
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AMSAN
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Acute motor and sensory axonal neuropathis
Leaves myelin intact |
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CIDP
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Chronic inflammatory demyelinating polyneuropathy
Takes longer to onset, progressive dx with relapsing numbness and weakness |
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Common diagnostic features of GBS (book)
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mm weakness (develop rapidly). Relative symmetry and usually distal to proximal
Paresthesias and hypesthesias Autonomic dysfx - tachycardia, arrhthmia Hx of flulike illness Elevation of CSF protein NCV tests abnormal |
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When does recovery occur after the plateau?
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2-4 weeks
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Features of GBS - somatic motor
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Distal to proximal and symmetrical
Leads to total paralysis of peripheral, axial, fascial, and extreocular mm |
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Features of GBS - somatic sensory
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Proprioception, crude/light touch, and delta fibers are f'd
C fibers left in tack (PAIN) |
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Features of GBS - CNs
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Depends where it hits - occurs in 50% of pts
facial, swallowing, optic, hearing |
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Features of GBS - Autonomic
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Dysautonomia - dec CO, dysarrhythmias, fluctuations in BP, respiratory issues, dec VR, ileus, urinary retention, orthostatic hypotension
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First clinical signs of GBS
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Weakness and pain, followed by severe bilateral weakness = falling
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Definitive diagnosis of GBS?
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Based on hx o s/s with precursor of infection and clinical criteria from lecture/book
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Clinical criteria from lecture notes for diagnosis of GBS?
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Ascending mo symmetrical, flaccid areflexia paralysis
Parestheaesias and hypesthaesias (mild) CN involvement (LMN VII) Autonomic dysfx: tachy, fluctuating BP, loss of sweating) Hx of flu like s/s Elevated CSF protein Abnormal nerve conduction studies Recovery after 2-4 wks of plateau |
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Other dx to consider in differential diagnosis of GBS
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SC compression
Transverse myelitis Myasthenia gravis Neoplastic meningitis Vasculitis neuropathy Paraneoplastic neurophathy |
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Hughes clinical imparment scale
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0: healthy
1: minor s/s, can run 2: walk independently 3: walk with AD 4: bed or chair bound 5: requires assisted ventilation 6: death |
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3 phases of GBS
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1. Acute: active demyelination and axonal damage
2: Plateau: appears to plateau from what we can test clinically 3: Recovery: Regererate myelin (schwann cells) to regrow axon to go back toward target tissue |
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3 recovery mechanisms during the recovery phase
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1. Regenerate myelin
2. Regrow axon 3. Re-innervation of remaining axons (compensatory) |
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How many ppl make a "full recovery"
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90% if you call AMB 150 ft with a 7 on the FIM full recovery
Pt will tell you they aren't the same |
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% that die and % that say there is nothing wrong with them after GBS
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5%
10% |
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What do the studies say about pts who have made a "full recovery"
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Life long changes and may not return to former lifestyles due to residual neuropathy
Evidence of some regeneration, but not full recovery. Nueropathy is consistent with axon loss/damage |
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Long term mm impairments according to Umphred?
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Ant tib
Foot and hand intrinsics Quads and gluts |
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Acute medical mgt of GBS
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MSK: ROM 15 min 1x/day
Skin: Positioning Resp: positioning so dif lobes get air in, ie sit up Eyes: drops b/c can't blink |
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Predictors for respiratory failure
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Lost neck flexion and EXT b/c this tells you the C3,4,5 is affected
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What is plasmaphoresis? Does it work? Adverse effects?
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Suck out plasma, RBCs, and WBCs and put cells back in.
Trials show shorter periods of mech vent and walked earlier Serious adverse effects relating to autonomic issues (hypotension, arrhythmias) |
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What is IVIg infusion? Does it work? Adverse effects?
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IV immunoglobulin therapy
Yeah, it works Costs a lot |
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Are corticosteroids helpful for GBS?
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Acute - NO! Cause more harm than good
Chronic - yeah, it helps |
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Overall PT goal during acute a and plataeu phase of GBS?
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Prevent secondary complications
Prepare for rehab |
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PT mgt of GBS during the recovery phase?
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Respiratory: breathing/coughing assist and training
Autonomic: tilt table and EOB Senosry: desensitization MSK: ya know |
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Why should pts in the recovery phase of GBS not work to the point of fatigue?
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Ex and fxt trng will not improve remyelination/reinnervation process and may cause overuse injuries
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What do pts report the most difficulty with after GBS?
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Power, pain in feet and hands (msk and nueropathic pain), chronic fatigue, weakness in selected areas
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