2. In 1859 The first cases were described by Landry, who
noted that the disease could produce motor and sensory
engagement, which committed the distal portion of
extremities and in some cases progressed in
caudocephalic or ascending direction to generalized
involvement .
In 1916, Guillain and Barre emphasized the importance
of albumin-cytological dissociation for clinical diagnosis
اكدو
3. - It is the most frequent form of polyneuritis seen in pediatric
it’s etiology is unknown.
- It is thought to be due to viral infection as it may follow measles,
chicken box and mumps( Post infectious polyneuritis).
Roughly two thirds of patients have a history of an antecedent GI or
RT infection.
Pathogenic triggers of GBS include EBV, CMV, the enteroviruses,
hepatitis A and B, varicella M.pneumoniae and Campylobacter
jejuni, which is perhaps the most common
These pathogens are believed to activate CD4+ helper-inducer T
cells, which are particularly important mediators of disease
-The condition may follow vaccination ( as rabies vaccine) or serum
sickness.
*Pathology :
There is demyelination of multiple peripheral nerves which is maximal
where the anterior and posterior roots fuse, the damage is mainly motor.
االتحاد منطقة عند شيء اكثر
Brain; meningitis encephalitis
Spinal cord: infection abcess truma
Anterior horn: Nerve injury muscle
Muscle junction
Muscle: myopathy hypokalemia myositis
hoshion syndrome
Nerve
Lower limp weakness
Parstgesia in lower limp
الطوارئ مال presentationال
Usually in
motor nerve
4. Clinical Picture:
1- Most often an unremarkable infection, such as upper respiratory infection,
often predates the onset of GBS by 14 days.
Many antecedent infections have been identified, including Campylobacter jejuni,
cytomegalovirus (CMV), Mycoplasma pneumonia, Epstein–Barr virus, influenza virus,
JEV.
Surgery, immunization, and parturition have also been associated with GBS
2- The symptom may occur insidiously one week or more after acute infection of
respiratory or GIT and consists of:
- Motor manifestations (predominant):
Bilateral symmetrical weakness which begins usually in the lower limbs and progresses
to involve the trunk, upper limb and the bulbar muscles ( ascending paralysis).
- Sensory manifestations : tender muscle and paraesthesia in some cases.
- autonomic manifestations: in some cases as transient urinary incontinence or
retention postural hypotension or hypertension.
Japanese encephalitis
ماضي
الوالدة مخاض
Tachycardia, bradycardia
5. Neurological examination is characterized by distal
and often proximal, relatively symmetrical,
weakness.
Although GBS is essentially a motor neuropathy,
sensory dysfunction is seen in a few patients. It is
seen more in a demyelinating form of GBS.
Sensory examination is often normal in the early
phase of disease. Facial or pharyngeal weakness is
commonly seen in GBS.
Diaphragmatic weakness due to phrenic nerve
involvement is also common.
Examination
Bilateral symmetrical weakness
Usually anreflexia
Sign of autonmic nerve ( tachycardia ,
bradycardia ,
Paralysis
Cranial nerve involves
كلهن منهن االهم
diaphragmatic paralysis
هو نعرف test in pediatric نسوي
delloved area ال علو ايدنه نخلي من
acsesive crying يصير
Early sign in
6. Approximately one third of hospitalized GBS patients
require mechanical ventilation due to respiratory
muscle or oropharyngeal weakness.
Tachycardia is common but more serious autonomic
nervous system dysfunction may occur, including life-
threatening arrhythmias, hypotension, hypertension,
and gastrointestinal dysmotility. nitroprusside
7. * Course :
1-Regressive in more than 90% of cases.
Recovery begins in 2-3 weeks in a descending
manner. Most pt. regain full muscle strength, some
left with residual weakness.
2- Progressive in few cases. Bulber
involvement leads to dysphagia and aspiration.
Involvement of respiratory muscles may lead to
respiratory failure.
3- A chronic relapsing form exist in 7% of the
cases: Weakness recurs intermittently or does not
improve over periods of months or yrs.
يتكرر
Slow
8. Diagnosis :-
a- History of antecedent infection, or injection of
sera may be of diagnostic help.
b-Clinical examination of paralytic
muscles.areflexai
c- CSF examination : Characterized by the presence
of Protein cell Dissociation ( Froin syndrome) i.e. there is
an increase in proteins without corresponding increase in
cells; However, protein cell dissociation is not Path
genomic of Guillian Barre since it may occur in other
disease as :
- Poliomyelitis; Infratentorial tumors; venous sinus
thrombosis ; lead poisoning; Spinal cord compression;
Diphtheria.
d- Nerve conduction velocity is decreased (
Diagnostic Investigation).
14 days.
واحد اهم
اضافات بعد اكو
9. DIFFERENTIAL DIAGNOSIS
(AFP)
Cerebral causes : encephalitis,bilateral strokes,acute cerebellar
ataxia syndrome posterior fossa structural lesion
Spinal cord lesion compression, transverse myelitis, vascular
injury)
AH lesion e.g. poliomyelitis and SMA
Peripheral neuropathy Chronic inflammatory demyelinating
polyneuropathy , (HIV) , Neurotoxic fish or shellfish poisoning
,Paraneoplastic neuropathy,Porphyria polyneuropathy, Toxic
neuropathies ( arsenic, thallium, organophosphates, lead)
Vasculitic neuropathies, Vitamin deficiency (B-12, folate,
thiamine)
Motor end plate disease Myasthenia Gravis, Tick paralysis
Muscle disease Myopathy hypokaemia and myositis
Conversion disorder/hysterical paralysis
10. Treatment :
1- Hospitalization: The pt should be admitted once
diagnosed, even if general condition is good;pt may need
mechanical ventilation at any time.
2- Care of feeding and avoidance of complications of being
bed ridden as bed sores.
3- Specific therapy : One of the following or both:
a- Intravenous Immunoglobulin's: 0.4 mg/kg /day over 5
days.( total dose = 2g).
b- Plasma Exchange ( Plasmapherisis): 5 exchanges of 50
ml/kg over 7-10 days.
4- Physiotherapy after recovery of the respiratory muscles.
chart نسويله admitted نسويلهم من
vita sign ال بيها
HR RR PB
Progress of disease
Spo2
Tenderness + numbness
Automatic nerve involvement ; tachycardia ,
bradycardia
Early sign of diaphragmatic involvement
+ difficult to feeding يصير
يحتاجون كلهم مو
ال بس admitted
agressive type
immunoglobulin
mainly IGG لكن كلهن
Monoclono antibody
بس واحد immunoglobulin اذا
Steroid use
يصير من
نسوي حتى
doseال مطلوب
11. ED MANAGEMENT
Intubation
if there is hypoxia ,rapidly declining respiratory function,
poor or weak cough reflex , and suspected aspiration.
Typically, intubation is indicated when the forced vital
capacity (FVC) is less than 15 mL/kg. .
Dysautomia
1. hypertension short acting b blocker or nitroprusside
2. hypotension-- ivf and supine position
3. bradycardia --- atropine
4. antiarrhythmic drugs or cardioversion may be indicated
ICU يحتاج ملن mechanical inventelation
sign ال نفس خالل من نعرف
pulmonary هي الثانيه indication وال
function test
Force vital capacity ال اذا
ml ١٥ من اقل
emergency or ICU بال نعالجه
according severity ال حسب هذا
autonomic nerve الن
يصيرون فممكن involvement
arrhythmia
12. ICU MANAGEMENT
1-Respiratory support
Respiratory support: serial assessment of ventilatory
status is needed, including measurements of vital
capacity and pulse oximetric monitoring.
Respiratory assistance should be considered when the
expiratory vital capacity decreases to less than 18
mL/kg or when a decrease in oxygen saturation is
noted (arterial PO2< 70 mm Hg).
Trachesotomy may be required in a patient with
prolonged respiratory failure, especially if mechanical
ventilation is required for more than 2 weeks.
13. 2-Management Of
Dyautonomia
Close monitoring of heart rate, blood pressure, and
cardiac arrhythmias allows early detection of life-
threatening situations. Critically ill patients require
close medical supervision in an ICU setting.
Antihypertensives and vasoactive drugs should be
used with caution in patients with autonomic
instability. Hemodynamic changes related to
autonomic dysfunction are usually transitory, and
patients rarely require long-term medications to treat
blood pressure or cardiac problems.
All joint involved except
one joint is elbow joint
usually 80%
part اول healing ال
هو involves t healing
involved بي صار واحد اخر
اول هو يتشافى واحد واخر
تاثر مفصل
Hypertension , hypotension
Nitroglerride
بال HTN لل نستخدمه الي
ER بال pediatric
