Guillain-Barré syndrome: Difference between revisions

Revision as of 20:07, 22 September 2023

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

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

@@ Line 17: / Line 17: @@
 ===Etiology===
-*''[[Campylobacter jejuni]]''
+*''[[Campylobacter jejuni|'''Campylobacter jejuni''']]''
-*[[Cytomegalovirus]]
+*[[Cytomegalovirus]], [[Haemophilus influenzae]], [[Mycoplasma pneumoniae]], [[Influenza]], [[HIV]]
+*Also [[COVID-19]], [[Zika virus]], [[EBV]], [[HSV]], [[VZV]], [[Chikungunya]], [[Escherichia coli]], [[Japanese encephalitis virus]]
-*[[Epstein-Barr virus]]
+*Non-infectious causes
-*[[Zika virus]]
-*[[HIV]]
+**[[Immunization]]
+**Surgery, trauma
-*Non-infectious causes, including [[immunization]], surgery, trauma, and [[hematopoietic stem cell transplantation]]
+**Medications, including [[TNF-α inhibitors]], [[tacrolimus]], [[suramin]], [[isotretinoin]], and [[immune checkpoint inhibitors]]
+**[[Hematopoietic stem cell transplantation]]
 === Pathophysiology ===
@@ Line 41: / Line 43: @@
 **[[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 [[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]]
 ==Further Reading==