Most common acute motor polyneuropathy, probably due to post-infectious etiology
mycoplasma and campylobacter infections as well as lymphoma have been associated.
Classically, bilateral ascending weakness, may go all the way to the face. Often heralded by paresthesias.
(rarely, there is a descending form Miller Fisher Variant, ataxia, areflexia, & opthalmoplegia)
Can develop acutely over days or subacutely over weeks.
motor>>than sensory, almost invariably have decreased reflexes,
If you intubate, DO NOT USE SUX. Consider autonomic dystability.
Get PFTS or ABG. Extensors of neck are quick/dirty test of impending failure
CSF: Albumin-cytologic disassociation: prot>400, WBC<10
In diff, tick paralysis
and/or IVIG 0.4 g/kg/day x 2 weeks
(Steroids are safe to give, but probably have no benefit as treatment)
occupational and physical therapy
Splinting to prevent Achilles’ contractures
Pts are prone to dysrhythmias so ecg monitoring is essential
Psychological support-feelings of hopelessness and depression are quite common
Speaking of knee jerks, what are his deep tendon reflexes? Sensory exam? I’ve had a couple of postop patients who seemed like they had GBS but improved quickly when their painless cervical disk herniations were repaired.
get vital capacity (make sure they can create a mouth seal) and check cough, if either fails, intubate in GBS, Myesthenia may get better quick, so you can try NIV
Critical Care 2011, 15:R65doi:10.1186/cc10043. Published: 21 February 2011
Conclusions: In patients admitted to ICU with Guillain-Barre syndrome and acute respiratory failure, the lack of foot flexion ability at the end of immune therapy predicts a prolonged duration of MV. Combined with a sciatic motor conduction block, it may be a strong argument to perform an early tracheotomy.
Sat. night palsy. Humeral compression of radial nerve
Wrist and finger drop.
When testing the ulna during this, place palm on flat surface to extend the fingers
Usually injured at elbow
Carpal tunnel Syndrome-L lumbricals (MCP flexion) and thumb O opposition A abduction and F flexion
Amytrophic Lateral Sclerosis (ALS)
upper and lower motor neurons, no sensory effects, hypotonic DTRs, atrophy, fasiculations
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