ASSIGNMENT ON-GULLIAN BARE SYNDROME.
Submitted to- Submitted By-
Ms.Niharika Tiwari Minakshi gangwar
Assistant Prof. MSN 2023399539
SSNSR.
Definition
Guillain-Barré Syndrome is an acute inflammatory demyelinating polyneuropathy
characterized by symmetrical muscle weakness, often beginning in the lower limbs and
ascending proximally. The condition typically follows an infectious illness, surgery, or
vaccination and can progress over hours to weeks.
INCIDENCE:
• 1-2 cases per 1,00000 people annually.
• Men are one and a half times more likely to be affected than women.
• It is the most common cause of acute non-trauma -related paralysis in the world.
• The syndrome is named after the French phydsicians George guillian and jean
alexandre barre and strohl.who described it in 1916.
CLASSIFICATION:
1.Acute Inflammatory Demyelinating Polyneuropathy( AIDP):
• Most common.
• Auto immune response against schwann cell.
2.Miller Fisher Syndrome:
• Rare variant
• Manifest as a descending paralysis.
• Usually affects the eye muscles first and presents with the traid of
opthalmoplegia,ataxia and areflexia.
3.Acute Motor Axonal Neuropathy:
• Also known as Chinese paralytic syndromre.
• Attacks motor nodes of ranvier and is prevalent in China and Mexico.
4. Acute Motor Sensory Axonal Neuropathy.
• Similar to AMAN.
• Affect the sensory with several axonal damage.
5. Acute panautomnomic Neuropathy :
• Is the most rare variant of GBS ,sometimes accompanied by encephalopathy.
• Frequently occurring symptoms include impaired sweating ,lack of tear formation
,photophobia, dryness of nasal and oral mucosa , itching and peeling of skin, nausea
,dysphagia and constipation unrelieved by laxative or alternating with diarrhea.
Etiology and Risk Factors
Although the exact cause of GBS is unknown, it is often associated with:
• Viral or bacterial infections:
o Campylobacter jejuni (most common bacterial cause)
o Cytomegalovirus (CMV)
o Epstein-Barr virus (EBV)
o Influenza virus
o HIV
• Surgical procedures
• Immunizations
• Trauma
• Malignancy (rare)
GBS is thought to be caused by an autoimmune response that mistakenly attacks peripheral
nerves, particularly the myelin sheath.
Pathophysiology
Guillain-Barré Syndrome is primarily an immune-mediated condition. The immune system,
after exposure to an infectious agent, produces antibodies that cross-react with components of
the peripheral nerves due to molecular mimicry.
There are several variants of GBS, with the most common being:
1. Acute Inflammatory Demyelinating Polyneuropathy (AIDP) – predominant in
Western countries.
2. Acute Motor Axonal Neuropathy (AMAN)
3. Acute Motor and Sensory Axonal Neuropathy (AMSAN)
4. Miller Fisher Syndrome (MFS) – characterized by ophthalmoplegia, ataxia, and
areflexia.
In AIDP, immune cells attack the myelin sheath of peripheral nerves, leading to impaired
nerve conduction, weakness, and paralysis.
Clinical Manifestations
The presentation of GBS varies, but classic features include:
• Ascending symmetrical weakness (begins in legs, progresses to arms and facial
muscles)
• Areflexia or hyporeflexia
• Paresthesia (tingling or numbness)
• Facial droop and dysphagia
• Respiratory distress (due to diaphragmatic weakness)
• Autonomic dysfunction:
o Tachycardia or bradycardia
o Labile blood pressure
o Urinary retention
o Sweating abnormalities
• Pain, particularly in the back and limbs
Symptoms typically progress over days to weeks, followed by a plateau phase, and then
gradual recovery.
Diagnosis
Diagnosis is primarily clinical, supported by the following investigations:
1. History and Physical Examination
• Recent infection
• Pattern of weakness (ascending)
• Reflex examination
2. Lumbar Puncture (CSF Analysis)
• Elevated protein level with normal white cell count (albuminocytologic dissociation)
3. Electrophysiological Studies
• Nerve conduction studies show demyelination features such as slowed conduction
velocity and conduction block.
4. MRI Spine
• May show nerve root enhancement
5. Blood Tests
• Rule out other causes; assess for infections
Medical Management
There is no specific cure for GBS, but early supportive and immunomodulatory treatments
can improve outcomes.
1. Immunotherapy
• Intravenous Immunoglobulin (IVIG)
o Administered over 5 days
o Neutralizes pathogenic antibodies
• Plasmapheresis (Plasma Exchange)
o Removes circulating antibodies
o Typically given as 4–6 exchanges over 8–10 days
2. Supportive Care
• Respiratory support: May require mechanical ventilation
• Pain control: Gabapentin, opioids
• Thromboprophylaxis: LMWH and compression stockings
• Nutritional support: Enteral or parenteral nutrition
• Physiotherapy: Prevent contractures and promote recovery
Complications
• Respiratory failure
• Cardiac arrhythmias
• Autonomic dysfunction
• Deep vein thrombosis and pulmonary embolism
• Pressure ulcers
• Depression and anxiety
• Residual weakness or disability
Nursing Management
Nurses play a crucial role in the care of patients with GBS, focusing on comprehensive,
supportive, and preventive care.
1. Assessment
• Monitor vital signs closely (especially respiratory rate, oxygen saturation, BP)
• Assess muscle strength and progression of paralysis
• Monitor for signs of autonomic dysfunction
• Pain assessment
2. Respiratory Management
• Encourage deep breathing and coughing
• Prepare for ventilator support if needed
• Suction airway if necessary
3. Mobility and Skin Care
• Turn and reposition every 2 hours
• Use pressure-relieving mattresses
• Perform passive range of motion exercises
• Prevent contractures and foot drop
4. Nutritional Support
• Monitor swallowing ability
• Provide high-protein, high-calorie diet
• Initiate tube feeding if necessary
5. Psychosocial Support
• Address fear and anxiety
• Provide emotional support and reassurance
• Involve family in care
6. Bladder and Bowel Care
• Monitor urine output
• Use intermittent catheterization as needed
• Maintain bowel regimen
7. Education
• Teach about disease course and recovery
• Educate family about home care and rehabilitation needs
Prognosis
The prognosis for Guillain-Barré Syndrome is generally favorable, although the course can
be prolonged. Most patients begin to recover within 2 to 4 weeks after progression stops.
Recovery may take several months to years.
• Full recovery: ~70% of patients
• Residual weakness: 15–20%
• Mortality rate: 3–7% (mostly due to complications)
Early intervention and supportive care are key to better outcomes.
Rehabilitation
Rehabilitation is essential in the recovery phase and focuses on:
• Regaining muscle strength
• Improving mobility
• Managing fatigue
• Coping strategies for psychological impact
Multidisciplinary rehabilitation including physiotherapists, occupational therapists, and
psychologists is recommended.
Conclusion
Guillain-Barré Syndrome is a medical emergency that requires timely recognition and a
multidisciplinary approach to management. Although it can lead to severe complications,
with proper medical and nursing care, most patients recover well. For nurses, understanding
the course of the disease, early signs of deterioration, and complications is vital to ensure
effective care delivery and improve patient outcomes.
References
1. Kumar, P., & Clark, M. (2022). Kumar and Clark’s Clinical Medicine. 10th Edition.
2. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (2021). 15th Edition.
3. National Institute of Neurological Disorders and Stroke. (2023). Guillain-Barré
Syndrome Fact Sheet.
4. Asbury, A. K., & Cornblath, D. R. (2020). Assessment of current diagnostic criteria
for Guillain-Barré Syndrome. Annals of Neurology.
5. WHO Guidelines for Management of Guillain-Barré Syndrome. (2022).
