Elisha Mkakirwa, a 6-year old male, presented with a 4-month history of blood in stool and 3 days of lower limb pain and tingling. Examination found hypotonia and reduced power in the lower limbs. Tests showed elevated CSF protein. He was diagnosed with Guillain-Barré syndrome, a rare disorder where the immune system attacks nerves, causing muscle weakness and paralysis. Treatment included IV antibiotics, physiotherapy, and supportive care. Prognosis is generally good, with most patients recovering over months, though some experience long-term weakness.

1. GUILLAIN - BARRE
SYNDROME

2. CASE PRESENTATION
• NAME: ELISHA MKAKIRWA
• AGE: 6 yrs
• SEX: M
• ADDRESS:MAJENGO
• DOA: 11/9/2023

3. • CHIEF COMPLAINTS
• Blood in stool for 4 months
• Lower limb pain for 3 days

4. • HPI:
• the patient was apparently well until 4 months ago when he started experiencing episodes of
blood in stool that were of sudden onset, loose stool mixed with blood, two episode per day
progressive with time was associated with abdominal pain which was generalized but was not
associated with nausea, loss of appetite, vomiting, abdominal distension, loss of weight, fever,
blood in urine or painful urination.
• also the patient started experiencing pain in the lower limbs for 3 days which was of sudden
onset, started on the left leg then progress to the right leg that was associated with tingling
sensation and inability to walk but was not associated with headache, blurred vision, convulsions,
loss of consciousness, loss of sensation, or lower limb swelling. Also the patient denies history of
trauma, playing in ponds and the baby received all doses of polio vaccines.

5. ROS:
• RS; No cough, DIB or chest pain
• CVS; No awareness of heartbeat, DIB on lying flat, chest pain of lower
limb swelling
• ENT; no discharge or bleeding per ear or nose
• MSS; No joint pain/stiffness or swelling
• Hematopoietic system; no easy bruising or bleeding tendencies

6. • No Hx of admission
• No trauma no surgical intervention
• No Hx of BT
• No allergy to food or drug
• No chronic illness in the family like DM, HTN, SCD
• in antenatal history
• not clear as the informant was the aunt
• Natal history
• born through SVD
• post natal history
• uneventful

7. FSHX;
• First child lives with his aunt, he is std one student
G/E
• Alert, afebrile, not pale, not cyanosed, no signs of dehydration, not
jaundiced, no lymphadenopathy, No LLE
• VITALS
• PR=110b/min, RR=25b/min, T=36.7C, SPO2=99% on RA

8. SYSTEMIC EXAMINATION
CNS;
• Alert, short and long term memory is intact, all cranial nerves are
intact,
• No meningeal signs,
• Normal bulkiness, normal tone in both upper limb and hypotonia in
both lower limbs.
• Power of 5/5 of boths upper limbs and power of 3/5 of both lower
limbs
• Reflexes were reduced with normal sensation

9. • P/Abdomen
• Normal abdominal shape moves with respiration, no superficial veins
dilatation no traditional mark or surgical scar no superficial or deep
tenderness no palpable organ enlargement, normal bowel sounds
• DRE- Normal

10. • RS:
• Normal chest contours, moves with respiration, symmetrical chest
expansion, normal position of trachea, normal tactile vocal fremitus,
normal resonance note and normal breath sound
• CVS:
• Warm extremities, no finger clubbing, capillary refill less than 3 secs,
no jugular venous distension.
• No precordial bulging, no hyperactivity, apex beat is at 4th ICS along
MCL, S1 AND S2 were heard with no added sound

11. • PDX;- Guillain Barre Syndrome
Bacillary dysentry
• DDX: Poliomylitis
Acute transverse myelitis
Schistosomiasis
Amobiasis

12. INVESTIGATIONS
• FBP-[WBC=9.10, HB=9.12, HTC=31.7, MCV=71.8, MCH=71.8]
• CRP-56.83
• Stool analysis
• Stool analysis for polio
• Stool for C/S-No pathogenic bacterial isolated
• CSF Analysis
• Nerve conduction studies

13. MANAGEMENT
• IV Ciprofloxacin 255mg BD 5/7
• T Ibuprofen 200 mg tds 3/7
• Physiotherapy

14. GUILLAIN - BARRE
SYNDROME
• DEFINITION
• Guillain Barre syndrome is a rare disorder in which body's immune
system attacks nerves and causes damage to the peripheral nerves.
• The nerve injury often causes muscle weakness,cause paralysis and
sensitivity problems, including pain, tingling or numbness

15. • The demyelinating form of Guillain-Barre syndrome destroys the
• protective covering of the peripheral nerves(myelin sheath),
preventing the nerves from transmitting signals to the brain

16. Types
• Once thought to be a single disorder, Guillain-Barre syndrome is now
known to occur in several forms. The
• main types are:
• – Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP)
The most common sign of AIDP is muscle weakness that starts in the
lower part of your body and spreads upward.
• – Miller Fisher Syndrome (MFS), in which paralysis starts in the eyes.
MFS is also associated with unsteady gait.
• – Acute Motor Axonal Neuropathy (AMAN) and Acute
• Motor-sensory Axonal Neuropathy (AMSAN

17. ETIOLOGY
• Bacterial infection
• Viral infection
• Protozoan infection
• Surgeries
• Blood Transfusion
• Transplantation
• Anesthesia
• Preceding heat stroke
• Preceding vaccination – Swine flu

18. PATHOPHYSIOLOGY
• Infection with organism contain amino acid that mimic peripheral
nerve myelin
• Edema and inflammation of affected nerves.
• Immune system fails to distinguish between foreign proteins and
nerve protein
.Demyelination of peripheral nerves
.Transmission of nerve impulses is stopped or slowed.
. Flaccid paralysis with muscle denervation and atrophy

19. Clinical Manifestations
• Hyporeflexia and weakness progress and may result in quadriplegia.
• Neuromuscular respiratory failure - demyelination of the nerves that
innervate the diaphragm and inter costal muscles results.
• Cranial Nerve deficit in (III- VII, IX- XII) with facial palsy.
• Ptosis, diplopia, facial weakness, dysarthria, dysphagia with pooling
of secretions.
• Sensory dysfunction with abnormal proprioception, sensory ataxia
can also occur.
• Gloves and stocking paraesthesias with slight disturbances of
sensibility.

20. • Weakness spreads to the arms and upper body
• The weakness may increase until muscles cannot be used at all and
may result in paralysis.
• Inability to walk due to muscle weakness and paralysis.
• Difficult to speaking, chewing and swallowing, various muscles
required to form speech are weakened

21. DIAGNOSIS
• Nerve conduction studies. Electrodes are taped to the peripheral
nerves. A small shock is passed through the nerve to measure the
speed of nerve signals.
• CSF analysis – elevated protein content up to 700mg/dl. Normal- 15-
45 mg/dl

22. MANAGEMENT
• Supportive care
• Ventiltory support
• Plasmapheresis (plasma exchange)– to remove abnormal antibodies
• IV Immunoglobulin's – stop antibody damaging cells.

23. COMPLICATIONS
• Complications can also include:
– Lingering weakness, numbness, or other odd sensations even after
recovery
– Heart or blood pressure problems
– Pain
– Slow bowel or bladder function
– Blood clots and bedsores due to paralysis

24. DIFFERENTIAL DIAGNOSIS
• Intracranial or spinal cord abnormalities- brain stem encephalitis or
cord compression
• Neuro muscular junction abnormalities – Myasthenia gravis
• Poliomyelitis with fever, meningeal signs
• Botulism –early loss of pupillary activity, descending paralysis
• Acute transverse myelitis Back pain, sphincter disturbances

25. PROGNOSIS
• Guillain Barre Syndrome is fatal in <2%.
• Most patients improve considerably over a period of months, but
about 30% of adult and even more in children have some residual
weakness at 3yrs.
• Patient with residual defects may require retraining, orthopedic
appliance or surgery