Guillain-Barré syndrome: Difference between revisions
From IDWiki
(Created page with "== Etiology == * ''Campylobacter jejuni'' * Cytomegalovirus * Epstein-Barr virus * Zika virus * HIV * Non-infectious causes, including imunization, surgery...") Â |
(→â€)  |
||
| (5 intermediate revisions by the same user not shown) | |||
| Line 1: | Line 1: | ||
== |
==Background== |
||
| ⚫ | |||
=== Types === |
|||
* [[Cytomegalovirus]] |
|||
* [[Epstein-Barr virus]] |
|||
*Guillain-Barré syndrome |
|||
* [[Zika virus]] |
|||
**Acute inflammatory demyelinating polyneuropathy (AIDP) |
|||
| ⚫ | |||
**Acute motor axonal neuropathy |
|||
* Non-infectious causes, including imunization, surgery, trauma, and hematopoietic stem cell transplantation |
|||
***Acute motor-sensory axonal neuropathy |
|||
***Acute motor-conduction-block neuropathy |
|||
***Pharyngeal-cervical-branchial weakness |
|||
*Miller Fisher syndrome |
|||
**Incomplete MFS |
|||
***Acute motor-ophthalmoparesis, without ataxia |
|||
***Acute ataxic neyropathy, without ophthalmoparesis |
|||
**Bickerstaff's brainstem encephalitis |
|||
===Etiology=== |
|||
| ⚫ | |||
*[[Cytomegalovirus]], [[Haemophilus influenzae]], [[Mycoplasma pneumoniae]], [[Influenza]], [[HIV]] |
|||
*Also [[COVID-19]], [[Zika virus]], [[EBV]], [[HSV]], [[VZV]], [[Chikungunya]], [[Escherichia coli]], [[Japanese encephalitis virus]] |
|||
*Non-infectious causes |
|||
**[[Immunization]] |
|||
**Surgery, trauma |
|||
**Medications, including [[TNF-α inhibitors]], [[tacrolimus]], [[suramin]], [[isotretinoin]], and [[immune checkpoint inhibitors]] |
|||
**[[Hematopoietic stem cell transplantation]] |
|||
=== Pathophysiology === |
|||
* Immune crossreactivity causes autoimmune destruction of either the myelin sheath (AIDP) or the axon itself |
|||
* Most common ADAM antibodies are anti-GM1 or anti-GD1a IgG, which recognize gangliosides |
|||
* Most common MFS antibody is anti-GQ1b IgG (in 90%) |
|||
===Epidemiology=== |
|||
*About 1 case per 100,000 people per year in Western countries |
|||
==Clinical Manifestations== |
|||
*Ascending paralysis ± sensory involvement |
|||
*Usually occurs 1 to 2 weeks after an immune-stimulating even such as illness or vaccination |
|||
**Preceding illness usually a gastrointestinal or respiratory infection |
|||
**[[Campylobacter jejuni]] is the most common causative organism identified |
|||
**Rare following influenza vaccination; most notable was the 1976 H1N1 vaccine, with about 1 in 100,000 vaccine recipients developing GBS |
|||
== Differential Diagnosis == |
|||
| ⚫ | |||
* [[Thiamine deficiency]] |
|||
* Polyneuropathy, including [[Arsenic poisoning|acute arsenic poisoning]] and other toxin-induced peripheral polyneuropathy, [[Lyme disease]], [[tick paralysis]], [[vasculitis]], [[sarcoidosis]], [[porphyria]] |
|||
* [[Leptomeningeal lymphoma]] |
|||
* [[Paraneoplastic syndrome]] |
|||
* [[Spinal cord disorder]] |
|||
* [[Botulism]], [[myasthenia gravis]], [[Lambert-Eaton syndrome]] |
|||
* Acute [[polymyositis]], [[dermatomyositis]], [[necrotizing myopathy]], [[critical illness neuropathy]] |
|||
== Investigations == |
|||
* Lumbar puncture, with CSF classically showing albuminocytologic dissociation (elevated protein with white count less than 50), though neither normal protein levels nor elevated white cells exclude the diagnosis[[CiteRef::al-hakem2023cs]] |
|||
==Further Reading== |
|||
*Guillain-Barré syndrome. ''Lancet''. 2016;388:717-727. doi: [https://doi.org/10.1016/S0140-6736(16)00339-1 10.1016/S0140-6736(16)00339-1] |
|||
[[Category:Neurology]] |
|||
[[Category:Infectious diseases]] |
|||
Latest revision as of 17:56, 30 September 2024
Background
Types
- Guillain-Barré syndrome
- Acute inflammatory demyelinating polyneuropathy (AIDP)
- Acute motor axonal neuropathy
- Acute motor-sensory axonal neuropathy
- Acute motor-conduction-block neuropathy
- Pharyngeal-cervical-branchial weakness
- Miller Fisher syndrome
- Incomplete MFS
- Acute motor-ophthalmoparesis, without ataxia
- Acute ataxic neyropathy, without ophthalmoparesis
- Bickerstaff's brainstem encephalitis
- Incomplete MFS
Etiology
- Campylobacter jejuni
- Cytomegalovirus, Haemophilus influenzae, Mycoplasma pneumoniae, Influenza, HIV
- Also COVID-19, Zika virus, EBV, HSV, VZV, Chikungunya, Escherichia coli, Japanese encephalitis virus
- Non-infectious causes
- Immunization
- Surgery, trauma
- Medications, including TNF-α inhibitors, tacrolimus, suramin, isotretinoin, and immune checkpoint inhibitors
- Hematopoietic stem cell transplantation
Pathophysiology
- Immune crossreactivity causes autoimmune destruction of either the myelin sheath (AIDP) or the axon itself
- Most common ADAM antibodies are anti-GM1 or anti-GD1a IgG, which recognize gangliosides
- Most common MFS antibody is anti-GQ1b IgG (in 90%)
Epidemiology
- About 1 case per 100,000 people per year in Western countries
Clinical Manifestations
- Ascending paralysis ± sensory involvement
- Usually occurs 1 to 2 weeks after an immune-stimulating even such as illness or vaccination
- Preceding illness usually a gastrointestinal or respiratory infection
- Campylobacter jejuni is the most common causative organism identified
- Rare following influenza vaccination; most notable was the 1976 H1N1 vaccine, with about 1 in 100,000 vaccine recipients developing GBS
Differential Diagnosis
- CIDP
- Thiamine deficiency
- Polyneuropathy, including acute arsenic poisoning and other toxin-induced peripheral polyneuropathy, Lyme disease, tick paralysis, vasculitis, sarcoidosis, porphyria
- Leptomeningeal lymphoma
- Paraneoplastic syndrome
- Spinal cord disorder
- Botulism, myasthenia gravis, Lambert-Eaton syndrome
- Acute polymyositis, dermatomyositis, necrotizing myopathy, critical illness neuropathy
Investigations
- Lumbar puncture, with CSF classically showing albuminocytologic dissociation (elevated protein with white count less than 50), though neither normal protein levels nor elevated white cells exclude the diagnosis1
Further Reading
- Guillain-Barré syndrome. Lancet. 2016;388:717-727. doi: 10.1016/S0140-6736(16)00339-1
References
- ^ Helle Al-Hakem, Alex Y. Doets, Amro Maher Stino, Sasha A. Zivkovic, Henning Andersen, Hugh J. Willison, David R. Cornblath, Kenneth C. Gorson, Zhahirul Islam, Quazi Deen Mohammad, Søren Hein Sindrup, Susumu Kusunoki, Amy Davidson, Carlos Casasnovas, Kathleen Bateman, James A.L. Miller, Bianca van den Berg, Christine Verboon, Joyce Roodbol, Sonja E. Leonhard, Samuel Arends, Linda W.G. Luijten, Luana Benedetti, Satoshi Kuwabara, Peter Van den Bergh, Soledad Monges, Girolama A. Marfia, Nortina Shahrizaila, Giuliana Galassi, Yann Pereon, Jan Bürmann, Krista Kuitwaard, Ruud P. Kleyweg, Cintia Marchesoni, MarÃa J. Sedano Tous, Luis Querol, Lorena MartÃn-Aguilar, Yuzhong Wang, Eduardo Nobile-Orazio, Simon Rinaldi, Angelo Schenone, Julio Pardo, Frederique H. Vermeij, Waqar Waheed, Helmar C. Lehmann, Volkan Granit, Beth Stein, Guido Cavaletti, Gerardo Gutiérrez-Gutiérrez, Fabio A. Barroso, Leo H. Visser, Hans D. Katzberg, Efthimios Dardiotis, Shahram Attarian, Anneke J. van der Kooi, Filip Eftimov, Paul W. Wirtz, Johnny P.A. Samijn, H. Jacobus Gilhuis, Robert D.M. Hadden, James K.L. Holt, Kazim A. Sheikh, Noah Kolb, Summer Karafiath, Michal Vytopil, Giovanni Antonini, Thomas E. Feasby, Catharina Faber, Hans Kramers, Mark Busby, Rhys C. Roberts, Nicholas J. Silvestri, Raffaella Fazio, Gert W. van Dijk, Marcel P.J. Garssen, Jan Verschuuren, Thomas Harbo, Bart C. Jacobs, R.A.C. Hughes, H.P. Hartung, L.C. de Koning, M. Mandarakas, M. van Woerkom, R.C. Reisin, S.W. Reddel, S.T. Hsieh, J.M. Addington, S. Ajroud-Driss, L. Alessandro, U.A. Badrising, G. Balloy, I.R. Bella, T.E. Bertorini, R. Bhavaraju-Sanka, M. Bianco, T.H. Brannagan, K. Brennan, C. Briani, S. Butterworth, C.C. Chao, S. Chen, K.G. Claeys, M.E. Conti, J.S. Cosgrove, M.C. Dalakas, M. Derejko, M.M. Dimachkie, A. Echaniz-Laguna, C. Fokke, T. Fujioka, E.A. Fulgenzi, T. GarcÃa Sobrino, C.J. Gijsbers, J.M. Gilchrist, J.M. Goldstein, J. Goodfellow, N.A. Goyal, S. Grisanti, L. Gutmann, M. Htut, K. Jellema, I. Jericó Pascual, M.C. Jimeno-Montero, K. Kaida, H. Kerkhoff, M. Khoshnoodi, L. Kiers, M. Kuwahara, J.Y. Kwan, S.S. Ladha, L. Landschoff Lassen, V. Lawson, E. Lee Pan, M.P.T. Lunn, H. Manji, C. Márquez Infante, E. Martinez Hernandez, G. Mataluni, M.G. Mattiazzi, C.J. McDermott, G.D. Meekins, G. MorÃs de la Tassa, C. Nascimbene, R.J. Nowak, P. Orizaola, M. Osei-Bonsu, A. Pardal, E. Pascual-Goñi, R.M. Pascuzzi, V. Prada, M. Pulley, I. Rojas-Marcos, S.A. Rudnicki, G.M. Sachs, L. Santoro, A. Savransky, L. Schwindling, Y. Sekiguchi, C.L. Sommer, C-Y Tan, H. Tankisi, P.T. Twydell, P. van Damme, T. van der Ree, R. van Koningsveld, J.D. Varrato, V. Vélez Santamaria, C. Walgaard, Y. Yamagishi, L. Zhang, MM, L. Zhou. CSF Findings in Relation to Clinical Characteristics, Subtype, and Disease Course in Patients With Guillain-Barré Syndrome. Neurology. 2023;100(23). doi:10.1212/wnl.0000000000207282.
