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Jessie Knight

on 14 November 2012

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Transcript of GBS

Complications Case Study Guillain-Barré
Syndrome Jessie
Knight Symptoms •Loss of reflexes in the arms and legs

•Low blood pressure or poor blood pressure control

•Muscle weakness or loss of muscle function (paralysis)


•Sensation changes, including pain and tingling

•Tenderness or muscle pain (may be a cramp-like pain)

•Uncoordinated movement (cannot walk without help) Typical •Breathing temporarily stops

•Can't take a deep breath

•Difficulty breathing

•Difficulty swallowing

•Feeling light-headed when standing


•Fainting Emergency •Blurred vision and double vision

•Clumsiness and falling

•Difficulty moving face muscles

•Muscle contractions

(sensation of feeling the heart beat) Other Tests Cerebrospinal fluid sample ("spinal tap") Pulmonary function
tests Electrocardiogram
(ECG) Electromyography
(EMG) Nerve conduction velocity test Breathing difficulty (respiratory failure)

Contractures of joints or other deformity

Deep vein thrombosis

Increased risk of infections

Low or unstable blood pressure Paralysis that is permanent


Skin damage (ulcers)

Sucking food or fluids into the lungs (aspiration) Immunoglobulin Therapy Immunoglobulins are added to the blood in large quantities, blocking the antibodies that cause inflammation. Treatment There is no cure

There are many treatments used to help:
a) reduce symptoms
b) treat complications
c) speed up recovery Plasmapheresis Used to remove the antibodies from the blood.

Involves taking blood from the body, usually from the arm, pumping it into a machine that removes the antibodies, and then sending it back into the body. Other
Treatments Blood thinners may be used to prevent blood clots.

If the diaphragm is weak, breathing support or even a breathing tube and ventilator may be needed.

Proper body positioning or a feeding tube may be used to prevent choking during feeding if the muscles used for swallowing are weak. Help Outlook GBS damages parts of nerves causing tingling, muscle weakness, and paralysis.

GBS most often affects the nerve’s covering (myelin sheath) which causes nerve signals to move more slowly.

Damage to other parts of the nerve can cause the nerve to stop working all together.

When this occurs the nerves cannot send signals efficiently, the muscles lose their ability to respond to the commands of the brain, and the brain receives fewer sensory signals from the rest of the body.

The result is an inability to feel heat, pain, and other sensations. Who discovered it? What is it? What causes it? "Case Study #101: Robert." Gaylord Specialty Healthcare. Web. 12 October 2012.

"Guillain-Barré Syndrome." A.D.A.M Medical Dictionary. Web. 12 October 2012.

"Guillain-Barré Syndrome." Boston Children's Hospital. Web. 11 October 2012.

"Guillain-Barré Syndrome." Johns Hopkins Medicine. Web. 11 October 2012.

"Guillan-Barré Syndrome Fact Sheet." National Institute of Neurological Disorders and
Stroke. Web. 14 October 2012. <http://www.ninds.nih.gov/disorders/gbs/detail_gbs.htm>

"History of GBS & CIDP, The." Guillain-Barré Syndrome Support Group. Web. 13
October 2012. <http://www.gbs.org.uk/history.html> References Recovery Recovery may take weeks, months, or even years.

Thirty percent of patients have some weakness after 3 years. Call a healthcare professional if you
have these symptoms:

•Cannot take a deep breath
•Decreased sensation
•Difficulty breathing
•Difficulty swallowing
•Loss of movement GBS may occur along with viral infections such as:
•Herpes simplex

May also occur with other medical conditions such as systemic lupus erythematosus or hodgkins disease.

Some people may get GBS after a bacterial infection.

A similar syndrome may occur after surgery, or when someone is critically ill (neuropathy of critical illness) Who's at risk? Robert was accepted for transfer and brought to Gaylord Hospital’s Ventilator Dependant program. Upon admission he was status post acute respiratory failure and quadriplegia likely secondary to Guillain-Barré syndrome. He was immediately evaluated by the respiratory team upon admission and was later evaluated for ventilator weaning by Gaylord’s ventilator team. Robert’s interdisciplinary care team (respiratory, neurology, psychology, and physical and occupational therapy) subsequently developed a personalized care plan to manage all aspects of his recovery. Robert did so well, with the support of his family and employer, that he was able to resume partial work responsibilities prior to discharge from Gaylord. Robert was in chronic respiratory failure requiring ventilator support. Ongoing weaning trials and pulmonary care were provided. He received routine tracheal suctioning, mouth care and chest physiotherapy. Later he tolerated a Passy-Muir valve and then plugging trials. Due to his underlying neuromuscular disease Robert required a prolonged ventilator weaning process over 5 to 6 weeks. He made steady strides in weaning and was eventually weaned completely off the ventilator. Pulmonary Hospitalization During his time as a patient in the Medically Complex Division, Robert experienced recurrent Pseudomonas urinary tract infections as a result of small bladder stones that developed from an excess of Vitamin D and calcium supplementation. With a removal of these supplements the stones were resolved with no further urinary issues. Infectious
Disease Upon admission to Gaylord, Robert had a degree of hypertension that was treated with Lopressor that was slowly tapered and eventually discontinued. He remained normotensive with no cardiovascular issues while at Gaylord. Cardiovascular Robert initially had significant dysphagia requiring nutritional support through a gastronomy tube. By working with the speech and language pathologist and with improvement in his respiratory status his dysphagia improved. He eventually started on an oral diet that advanced to a full regular diet. Once he was meeting his calorie needs the G-tube was removed. He was slightly hypomagnesemic and was placed on magnesium supplementation. GI / Nutrition Robert’s neurological status improved slowly throughout his hospitalization. He regained more reflexes and then muscle contractions that eventually progressed to a more functional status. Neurology Robert participated in aggressive individualized physical and occupational therapy programs. He was given aquatic therapy the in heated pool and used a head-controlled wheelchair. By the time he was discharged his overall evaluation showed increased strength and trunk musculature. He had 40% strength in his bilateral upper extremities and was participating with the tilt table with occupational therapy. Before being discharged, Gaylord’s care team coordinated a home-based therapy program so Robert could continue his recovery with his wife and young son. He continued with aggressive outpatient physical and occupational therapies and followed up with a neurologist. Therapy History Robert was a 32-year-old Caucasian male whose only health issue, prior to a diagnosis of Guillain-Barré syndrome, was a history of lumbar disc disease. He initially developed upper respiratory and flu-like symptoms that were treated at a walk-in-clinic with azithromycin. After 3 days he developed weakness in his distal upper extremities that progressed to his lower extremities and within 24 hours he was unable to walk. After admittance to a local ICU Robert developed acute respiratory failure. He was presumed to have Guillain-Barré syndrome and received 3 doses of IVIG. He was transferred to Yale-New Haven Hospital where he had an infectious disease consult and was maintained on azithromycin, ceftriaxone and vancomycin for possible Lyme disease. His sputum culture was positive for Haemophilus influenza. Robert received a total of 5 doses of IVIG and his EMG was consistent for acute motor-axonal neuropathy. Toward the end of his treatment at Yale-New Haven he had bilateral extremity 1+ reflexes but otherwise remained quadriparetic without other reflexes and was ventilator dependent. He was trialed twice on flow-by but failed and subsequently underwent a tracheostomy and gastrostomy tube placement. His overall condition stabilized and he was admitted to Gaylord Hospital for further care and management including ventilator weaning. Case Study #101: Robert
Gaylord Specialty Healthcare What does it do? A serious disorder that occurs when the body’s defense (immune) system mistakenly attacks part of the nervous system. This leads to nerve inflammation that causes muscle weakness and other symptoms. Guillain Barre Strohl Studied at Saltpêtrière in Paris at the turn of the century and specialized in neurology.

Served as doctors for the French Army in World War I and studied paralyzed soldiers.

Published first paper documenting their findings in 1916. Exact cause is unknown

Often follows a minor infection

Most of the time, signs of the original infection have disappeared before the symptoms of GBS begin

It may also appear a few days or weeks after a surgery
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