Guillain-Barré Syndrome (GBS)

Vignette says a 42 year old male presents to the emergency department with a progressive weakness in his both legs along with tingling sensation in his feet over the past 4 days; He also suggests that the weakness has gradually spread upwards in past 24 hours, now affecting his arms and causing difficulty in swallowing; He states that he had developed bloody diarrhea 2 weeks back after consumption of poultry products; On examination he has bilateral lower limb weakness with MRC grade of 3/5 in both limbs along with absent deep tendon reflexes in both knees and ankles; CSF shows elevated protein with normal cell count; Electrophysiologic studies show prolonged latency, decreased motor nerve conduction velocities and amplitude; MRI of the brain and spinal cord is normal; Serology shows Campylobacter jejuni infection; Diagnosis?

Diagnosis is GBS following campylobacter infection.

Guillain-Barré Syndrome (GBS) is an autoimmune demyelinating disorder of peripheral nervous system that usually following gastrointestinal or respiratory infections; Molecular mimicry between microbe and nerve antigens; Commonly associated with Campylobacter jejuni, Mycoplasma pneumoniae, cytomegalovirus, Epstein Barr, influenza A, Zika, HIV.

Presents with bilateral symmetric progressive, ascending flaccid paralysis or weakness of limbs, decreased deep tendon reflexes and distal numbness or dysesthesias (i.e. feeling of pins and needles) of extremities.

Diagnosis:-
1. CSF shows elevated protein with normal cell count (i.e. albuminocytologic dissociation).
2. Electrophysiologic studies (EMG/NCV) show demyelination in peripheral nerves (i.e. prolonged latency, decreased motor nerve conduction velocities and amplitude).
3. MRI of the brain and spinal cord is usually normal or shows enhancement of anterior nerve roots/cauda equina.
4. Spirometry (i.e. FVC) is used to assess pulmonary function. 

Treatment:-
1. Intravenous immunoglobulin (i.e. IVIG) or Plasmapheresis is the mainstay of treatment. 
2. Supportive measures like DVT prophylaxis, Respiratory monitoring and Physical therapy.

Figure:- Guillain-Barré Syndrome