G ui llain- barre syndrome nazar


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G ui llain- barre syndrome nazar

  2. 2.  Landrys ascending paralysis. Acute inflammatory demyleniating poly neuropathy (AIDP) Acute idiopathic polyneuritis French polio Landry Guillain Barre syndrome.
  3. 3.  GBS is an autoimmune disease marked by an acute inflammation of the peripheral nerves effecting arms and legs. It is characterized by weakness and numbness or tingling in legs, arms, and possible loss of movement in upper body and face. Involves destruction of myelin sheath surrounding largest most myelinated sensory motor fiber. Resulted in disruption of proprioception and weakness of limbs. In more severe cases complete paralysis and breathing difficulty noted. In most cases GBS follows recent viral and bacterial infections.
  4. 4.  No clear cause. Neither contagious nor hereditary. Possible vaccine causal link. Autoimmune----body produces antibodies that damages myelin sheath. In about half of all cases the onset of symdrom follows viral or bacterial infections. Camphylobacteriosis---usually eating uncooked poultry. Influenza Gastrointestinal viral infection. HIV
  5. 5. •Porphyrin----rare disease of RBC.•Viral hepatitis.• Epidural anesthesia.•Thrombolytic agents.•Small number of cases have been known to occur after minor surgeries• GBS has been associated with systemic processes like•Hodgkin’s disease.•SLE•Sarcoidosis•EBV, CMV,•Lyme disease.•Mycoplasma.
  6. 6.  Hypotonia and areflexia (absence of reflexes). Numbness and tingling in hands and feet Distal progression: Muscle weakness Diminished reflexes and proprioception, decreased sensation, For some progresses to trunk, face, and cranial nerves, resulting in difficulty swallowing, chewing, speaking, and facial expressions Deep, aching pain/hypersensitivity to touch Respiratory/cardiac dysfunction and failure.
  7. 7. •The initial symptoms are SENSORY CHANGES: paresthesia,numbness; usually mild; 70% pts have sensory abnormalities.•burning,tingling,shocklike,persistent in 5-10%•WEAKNESS- ascending and symmetrical, lower limbsinvolved first, proximal muscles involved earlier; developsacutely and progresses; wide variations in severity.•AUTONOMIC CHANGES: tachycardia, bradycardia, facialflushing, paroxysmal HTN, orthostatic hypotension,anhidrosis,diaphoresis, urinary retention, ileus, dizziness;more common if severe weakness or respiratory failure.
  8. 8.  It is characterized by focal segmental demyelination with perivascular and endoneurial infiltrates of lymphocytes and monocytes or macrophages. These lesions are scattered throughout the nerves, nerve roots. And cranial nerves. In particularly severe lesions, there is both axonal degeneration and segmental demyelination During recovery, remyelination occurs, but the lymphocytic infiltrates may persist.
  9. 9.  Affects 2/100000 annually. None-discriminatory, can effects persons of any gender, age.
  10. 10.  80% experience complete recovery. Recovery may last for 2 months to 2 years, It has three distinct phases. Acute (4 weeks) initial rapid onset of symptoms. Plateau (few days to few weeks). Symptoms neither worsen nor improve. Recovery (gradual improvement or recovery is accompanied by pain and tingling in limbs. Childrens makes better recovery than adults. Recent studies on the disease demonstrate that approximately 80% patients have Myelin loss while 20% have Axon loss. 5% dies because of cardiopulmonary complications.
  11. 11.  GBS is difficult to diagnose because of symptoms varying and due to no specific cause. Physical and neurological examination. Lumber puncture (high protein contents is demonstrated in CSF). NCS (showing flowing o nerve conduction in nerves root and in peripheral nerves EMG (Ineffective tool)
  12. 12.  Limited physical mobility. Inability to engage in meaningful occupation because of pain. Extreme muscle weakness in arms and legs. Fatigue. Sensory functions impaired. Mental confusion.
  13. 13.  Medical GBS should be considered as medical emergency. Intravenous immunoglobulin therapy. It prevents immune system from further attacking Schwann cells and myelin sheath, brocking receptor and microphage Plasmapheresis Filters blood plasma to remove antibodies. It can shorten the course, alleviates symptoms in prevent paralysis.
  14. 14. •Corticosteroids•It inhibit inflammation associated with symptoms.• Muscle relaxant/ anticonvulsant / pain killer.
  15. 15.  Before recovery begins (PROM) After symptoms subside (ARON) Positioning . Active muscle strengthening. Mobility skills. Training with adaptive devices such as wheel chairs or braces. Hydrotherapy. Whirlpool hydrotherapy may release pain and useful in retraining the movements of effected limbs. Counseling. To feel positive about their disease.