Guillain-Barré syndrome: Difference between revisions

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== Background ==
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==Background==
   
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=== Types ===
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* Causes either acute inflammatory demyelinating polyneuropathy, or acute motor axonal neuropathy, or acute motor and sensory axonal neuropathy
  
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*Guillain-Barré syndrome
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**Acute inflammatory demyelinating polyneuropathy (AIDP)
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**Acute motor axonal neuropathy
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***Acute motor-sensory axonal neuropathy
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***Acute motor-conduction-block neuropathy
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***Pharyngeal-cervical-branchial weakness
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*Miller Fisher syndrome
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**Incomplete MFS
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***Acute motor-ophthalmoparesis, without ataxia
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***Acute ataxic neyropathy, without ophthalmoparesis
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**Bickerstaff's brainstem encephalitis
   
 
===Etiology===
  
===Etiology===
   
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*''[[Campylobacter jejuni]]''
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*''[[Campylobacter jejuni|'''Campylobacter jejuni''']]''
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*[[Cytomegalovirus]]
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*[[Cytomegalovirus]], [[Haemophilus influenzae]], [[Mycoplasma pneumoniae]], [[Influenza]], [[HIV]]
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*Also [[COVID-19]], [[Zika virus]], [[EBV]], [[HSV]], [[VZV]], [[Chikungunya]], [[Escherichia coli]], [[Japanese encephalitis virus]]
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*[[Epstein-Barr virus]]
  
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*Non-infectious causes
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*[[Zika virus]]
  
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*[[HIV]]
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**[[Immunization]]
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**Surgery, trauma
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*Non-infectious causes, including immunization, surgery, trauma, and hematopoietic stem cell transplantation
  
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**Medications, including [[TNF-α inhibitors]], [[tacrolimus]], [[suramin]], [[isotretinoin]], and [[immune checkpoint inhibitors]]
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**[[Hematopoietic stem cell transplantation]]
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=== Pathophysiology ===
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* Immune crossreactivity causes autoimmune destruction of either the myelin sheath (AIDP) or the axon itself
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* Most common ADAM antibodies are anti-GM1 or anti-GD1a IgG, which recognize gangliosides
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* Most common MFS antibody is anti-GQ1b IgG (in 90%)
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===Epidemiology===
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*About 1 case per 100,000 people per year in Western countries
   
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==Clinical Manifestations==
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=== Epidemiology ===
  
   
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*Ascending paralysis ± sensory involvement
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* About 1 case per 100,000 people per year in Western countries
  
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*Usually occurs 1 to 2 weeks after an immune-stimulating even such as illness or vaccination
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**Preceding illness usually a gastrointestinal or respiratory infection
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**[[Campylobacter jejuni]] is the most common causative organism identified
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**Rare following influenza vaccination; most notable was the 1976 H1N1 vaccine, with about 1 in 100,000 vaccine recipients developing GBS
   
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== Clinical Manifestations ==
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== Differential Diagnosis ==
   
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* [[CIDP]]
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* Ascending paralysis ± sensory involvement
  
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* [[Thiamine deficiency]]
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* Usually occurs 1 to 2 weeks after an immune-stimulating even such as illness or vaccination
  
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* Polyneuropathy, including [[Arsenic poisoning|acute arsenic poisoning]] and other toxin-induced peripheral polyneuropathy, [[Lyme disease]], [[tick paralysis]], [[vasculitis]], [[sarcoidosis]], [[porphyria]]
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** Preceding illness usually a gastrointestinal or respiratory infection
  
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* [[Leptomeningeal lymphoma]]
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** [[Campylobacter jejuni]] is the most common causative organism identified
  
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* [[Paraneoplastic syndrome]]
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** Rare following influenza vaccination; most notable was the 1976 H1N1 vaccine, with about 1 in 100,000 vaccine recipients developing GBS
  
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* [[Spinal cord disorder]]
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* [[Botulism]], [[myasthenia gravis]], [[Lambert-Eaton syndrome]]
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* Acute [[polymyositis]], [[dermatomyositis]], [[necrotizing myopathy]], [[critical illness neuropathy]]
   
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== Further Reading ==
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==Further Reading==
   
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* 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]
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*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:Neurology]]

Latest revision as of 16:07, 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

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

Further Reading

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