gullian barre syndrome
TRANSCRIPT
GUILLAIN BARRE SYNDROME
NO. Group members
1. AINUL ASRAH BINTI ZAINUDDIN
2. MOHAMMAD FAZLI BIN NORMAN
3. NOR IZZATIE BINTI HAMDAN
4. NURFARAHIN BINTI MOHAMAD FARZEE
5. SITI NOR SYAFAWANI BINTI MOHAMAD SYAH
Introduction Guillain-Barre syndrome is a disorder that causes
damage to the peripheral nerves. The nerve injury often
causes muscle weakness, often does cause paralysis
and sensitivity problems, including pain, tingling, “pins
and needles in the skin” or some numbness.
Guillain-Barre syndrome is an autoimmune disorder in
which the body’s immune system attacks and destroys
the myelin sheath that surrounds nerve cells of the large
body, like an insulator covering a water pipe. If myelin is
destroyed, nerve impulses traveling very slowly and can
be interrupted. If the muscles are not properly stimulated
through the nerves will not function correctly.
Etiology No one yet knows why Guillain-Barré
There are varying degrees of severity
Onset usually occurs 1-3 weeks after exposure to a viral infection
Destruction most often occurs in segments between the Nodes of Ranvier
Body's immune system begins to attack the body itself (autoimmune disease)
When the GBS is preceded by a viral infection, there is no evidence of direct viral infection of peripheral nerves or nerve roots.
Usually Guillain-Barré occurs a few days or weeks after the patient has had symptoms of a respiratory or gastrointestinal viral infection.
surgery will trigger the syndrome
vaccinations may increase the risk of GBS
Contaminated
food or water
Pathogen (C.jejuni)
+
Immature antigen
presenting cell
Innate immune response
MHC (Mature, differentiated antigen
presenting cell) migrates to lymph nodes.
Activate CD4T cells, in the same time
activate B cells
Cell mediated + humoral immunity
response
Pathogen & host have
identical amino acid
sequences, antigens in its
capsule are shared w/
nerves
Antibodies produce
Activation of the
complement system &
phagocytosis of bacteria
Molecular mimicry
Antibodies that produced cross react with myelin,
Lymphocytes and macrophages circulate in blood
& find myelin.
Lymphocytic infiltration of spinal roots &
peripheral nerves.
Macrophage – mediated , multifocal stripping of
myelin & axonal damage.
Defects the propagation of electrical nerve
impulses, w/ eventual conduction block
Guillian – Barre Syndrome (GBS
Cardinal Features of GBS
Progressive weakness of two or more limb (Unterman,
Chapman & Shoenfeld, 2012), sometimes can have
difficulty in walking (Seneviratne, 2000)
Fairly symmetric muscle weakness on both proximal
and distal (Winer, 2008)
Hypotonia (Frontera, 2009) & muscle wasting
(Seneviratne, 2000)
Facial, respiratory, and bulbar muscles weakness.
(Seneviratne, 2000)
Miller Fisher syndrome (Fisher, 1956), described
with ataxia, areflexia (Unterman, Chapman &
Shoenfeld, 2012) & ophtalmoplegia, mild limb
weakness, ptosis, facial & bulbar palsy.
(Seneviratne, 2000)
Exaggerated DTR, in ACUTE PHASE: hyperreflexia
(Seneviratne, 2000)
AMAN: with retained or brisk reflexes (Winer, 2008)
Preservation of cutaneous relfexes (Bounduelie,
1998)
Respiratory muscles weakness followed by
ophtalmoplegia & tongue weakness (Seneviratne,
2000) presence with clear dyspnoea, failing resp.
effort d/t falling VC (Winer, 2008)
Bulbar weakness predisposing to pulmonary
aspiration requiring tracheal intubation for airway
protection (Gupta & Summors, 2001)
Respiratory sign
Neurological Features
Cranial Nerve deficit (Franz, 2000) in (III- VII, IX- XII)
with facial palsy (Seneviratne, 2000)
Ptosis, opthalmoparesis (diplopia), facial weakness,
dysarthria, dysphagia with pooling of secretions.
Sensory dysfunction (Seneviratne, 2000) with
abnormal proprioception, sensory ataxia can also
occur (Frontera, 2009)
Gloves and stocking paraesthesias (Gupta &
Summors, 2001) with slight disturbances of
sensibility (Bounduelie, 1998)
Type of GBS Characteristics
Acute inflammatory
demylinating
polyradiculoneurpathy (AIDP)
• Primary demylinating
• Progressive, symmetric weakness,
absent or depressed DTR.
Acute sensorimotor axonal
neuropathy (ASMAN)
Up to 1/3 may be hyperreflexic
Miller Fisher Syndrome • Triad of ataxia, ophtalmoplegia, and
areflexia.
• 1/3 develop extremity weakness
Acute Pandysautonomia • Symphatetic and parasymphatetic
involvement.
•Orthostatic hypotension
•Urinary retention
•Diarrhea, abdominal pain, ileus, vomitting
•Pupillary abnormalities
•Reflexed diminished
•Decreased sweating, salivation &
lacrimation (Gupta & Summors, 2001)
Muscle weakness (both side of the body). (Jewett,2010).
Weakness spreads to the arms and upper body. The
weakness may increase until muscles cannot be used at all
and may result in paralysis.
Muscle ache, pains or cramps.
Occurred at the large muscles, such as the thighs, lower
back, buttocks and shoulders as earliest symptom.
Experiences loss or reduction of the sense of touch, or
abnormal sensations.
Inability to walk due to muscle weakness and paralysis.
(Daniel & Green, 2011).
Difficult to speaking, chewing and swallowing.
(Healthwise, 2010).
various muscles required to form speech are weakened.
Breathing difficulties.
Blurred vision.
Dizziness, migraines, pain in the back of head.
(Hassan,2010).
Pain in bladder area due to bladder dysfunction.
(Hassan,2010).
Among the first symptoms are pain, numbness,
paraesthesia, or weakness in the limbs. ( Doorn,
Ruts, Jacobs, 2008 ).
GBS is an autoimmune acute peripheral neuropathy
that cause limb weakness that progresses over a
period of days and up to 4 weeks. (Unterman,
Chapman, Shoenfeld, 2012).
REFRENCES
Internet
Guillain-Barre Syndrome. Davids, Dr. Heather. University of Colorado
School of Medicine. 2006. Viewed at:
http://www.emedicine.com/pmr/topic48.htm
"Guillain-Barré Syndrome Fact Sheet." NINDS. NIH Publication No. 05-
2902. Viewed at
http://www.ninds.nih.gov/disorders/gbs/detail_gbs.htm
Van Doorn, P. A., (March 2003). Gullain-Barré syndrome. Retrieved
September 2, 2008 from http://www.orpha.net/data/patho/GB/uk-
Guillain.pdf
Thomas. C. L. (18). (1997). Taber’s Encyclopedic Medical Dictionary.
Philadelphia: F.A. Davis Company.
Http://www.healthscout.com/ency/68/653/main.html
Guillain Barre Syndrome Pathophysiology. (n.d.). Retrieve Disember
22nd , from http://www.scribd.com/doc/22044205/Guillain-Barre-
Syndrome-Pathophysiology
Guillain Barre Syndrome. (2012, may 21st ). The New York Times.
Retrieved Disember 22nd, from
http://health.nytimes.com/health/guides/disease/guillain-barre-
syndrome/overview.html
Guillain Barre Syndrome. (2011, May 28th). Retrieved Disember 22nd,
from http://www.mayoclinic.com/health/guillain-barre-
syndrome/DS00413/DSECTION=causes
Guillain Barre Syndrome. (2012, May 21st). Retrieved Disember 22nd,
from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001704/
Andary, M. T. (2012, august 29th). Guillian Barre Syndrome. Retrieved
Disember 22nd, from http://emedicine.medscape.com/article/315632-
overview#a0104
Stephanie S. J., (2010). Do You Know About Guillain-Barre
Syndrome?. Retrieved December, 24, 2012, from
http://www.wellsphere.com/nursing-article/do-you-know-about-
guillain-barre-syndrome/1120732.
Sonya D., & Richard G. (2011). Guillain-barré Syndrome
Anaesthesia Tutorial Of The Week 238.
Guillain-Barré Syndrome : Definition, Symptoms, Diagnosis,
Prevention And Treatment
http://healthlineinfo.com/guillain-barre-syndrome-definition-
symptoms-diagnosis-prevention-and-treatment.html
Books
Umphred, D.A. (2001). Neurological Rehabilitation (4th ed.).
United States: Mosby.
Molecular Mimicry. (2008, january 21st). Retrieved Disember 26th, from
http://www.mult-sclerosis.org/MolecularMimicry.html
Frank, S. A. (2002). Immunology and Evolution of Infectious Disease.:
chapter 4 specificity and cross reactivity. Retrieved Disember 26th,
from http://www.ncbi.nlm.nih.gov/books/NBK2396/
Journals
Van Doom, P. A., Ruts, L., & Jacobs, B.C. (October, 2008). Clinal
features, pathogenesis, and treatment of Guillain Barre Syndrome. Vol
7. Retrieved Disember 24th, from
http://faculty.ksu.edu.sa/23491/peripheral%20neuropathy/GBS_review.
Ang, C. W., Jacobs, B.C., & Laman, J.D. (February, 2004). The Guillain
Barre Syndrome: a true case of molecular mimicry. Vol.25 No.2.
Retrieved Disember 27th, from www.sciencedirect.com
Seneviratne, U. (2000), Guillain-Barré Syndrome,
Postgraduate Medical Journal, 76(902). Retrieved from
http://www.imj.bmj/content/76/902/774.fu/on on December
22, 2012.
Winer, J.B. (2008), Guillain-Barré Syndrome, BMJ.
Bonduelie, M. (1998), Guillain-Barré Syndrome, Archives of
Nuerology, 55(11). Retrieved from
http://archneur.jamanetwork.com/article.aspx?articleid=7743
81 on December 22, 2012.
Gupta, A. K. & Summors, A. (2001), Neuroanaesthesia and
Critical Care, Greenwich Medical Media LTD: London.
Frontera, J. A (2009), Decision Making in Neurocritical Care,
Thieme Medical Publishers Inc: United States
Unterman, A., Chapman, J. & Shoenfeld, Y. (2012), Guillain-
Barré Syndrome, The General Practice Guide to
Autoimmune Diseases: PABST Science Publishers.
Pieter, A. D., Liselotte R., & Bart C. J. (2008). Clinical features,
pathogenesis, and treatment of Guillain-Barré syndrome. The Lancet
Neurology. Retrieved December 24, 2012, from
http://faculty.ksu.edu.sa/23491/peripheral%20neuropathy/GBS_review.
Avraham U., Joab C., Yehuda S., (2012). Guillain-Barr´e syndrome. In
Y. Shoenfeld and P. L. Meroni (Ed.). The General Practice Guide to
Autoimmune Diseases, (pp219-223). Lengerich: Pabst Science
Publishers
WebMD. (2010). Brain & Nervous System Health. Retrieved December
24, 2012, from http://www.webmd.com/brain/tc/guillain-barre-syndrome-
symptoms.
Tauqeer H. (Ed.).(2010). Guillain Barre Syndrome, Symptoms,
Diagnosis and Treatment. Retrieved from December 24, 2012, from
http://syndrome.ezinemark.com/guillain-barre-syndrome-symptoms-
diagnosis-and-treatment-3b893de803b.html .