Guillain-Barré syndrome is an acute inflammatory, and, in addition, demyelinating polyradiculoneuropathy, which has an autoimmune etiology. A characteristic sign of this disease is the development of peripheral paralysis and protein, as well as cellular dissociation in the cerebrospinal fluid. The diagnosis of this syndrome is established in the presence of increasing weakness along with areflexion in more than one limb.
At the same time, other neurological diseases that are accompanied by peripheral paresis in the form of poliomyelitis, an acute period of stem stroke, toxic lesions of the nervous system and so on are completely excluded. Treatment of patients with this syndrome is carried out in a hospital, as the patient may require artificial ventilation of the lungs.
Syndrome Description
Nowadays, the following four main clinical types are distinguished within the framework of Guillain-Barré syndrome:
- The classic form of pathology. It is expressed in acute demyelinating polyradiculoneuropathy, which occurs in ninety percent of cases.
- Axonal form of the disease. In this case, acute motor axonal neuropathy develops. A characteristic sign of this form is an isolated lesion of the motor fiber. Against the background of acute motor-sensory neuropathy, motor and sensory fibers are simultaneously affected.
- Miller-Fisher syndrome also acts as another form of this pathology, which is characterized by ophthalmoplegia along with cerebellar ataxia, and in addition, areflexia against the background of mild paresis.
Atypical variants of the disease
In addition to the above forms of Guillain-Barré pathology, at present, experts distinguish several more atypical variants of the disease:
- Acute pandizavtonomichesky type.
- The acute form of sensory neuropathy.
- The acute form of cranial polyneuropathy (it should be noted that this variety is quite rare).
Consider the symptoms of Guillain-Barré syndrome.
Reasons for the development of pathology
About this disease, science became known more than a hundred years ago. However, all the factors that provoke it are not fully understood. It can be assumed that the disease develops due to a malfunction of the immune system. When an infection gets into the body of a healthy person, a protective reaction occurs, a kind of fight against viruses and bacteria. But in this case, immunity perceives neurons for foreign agents.
The immune system destroys the nervous system, resulting in pathology. Why this happens is a little-studied question. Common triggering factors:
- Brain injuries.
- Viral diseases.
- Heredity.
Other reasons are not excluded. The syndrome is diagnosed in people with signs of allergies, as well as those who have had chemotherapy or complex surgery.
Symptoms of the syndrome
For this pathology, the presence of the following symptoms is characteristic:
- The appearance of muscle weakness. Most often, this feeling occurs in the arms and legs. As a rule, weakness initially develops in the shoulders and hips, and then goes on to the lower legs and forearms. The feeling of weakness is symmetrical on both sides, and the respiratory muscles are often affected.
- Violation of breathing, which manifests itself in the inability to breathe independently. This symptom is observed in a third of patients with Guillain-Barré syndrome.
- Violation of swallowing: a person may choke while taking liquid or solid foods.
- Pain in the back and limbs: persistent and pulling, poorly treatable.
- Numbness with tingling in the skin of the limbs.
- Rapid or, conversely, sharply slowed heartbeat along with sharp fluctuations in pressure.
- Urinary incontinence.
- Doubling in the eyes along with strabismus.
- Shakiness of gait, lack of coordination in movements.
Symptoms of Guillain-Barré syndrome can manifest themselves in different ways in everyone.
The clinical picture of pathology
So, the first signs of the syndrome described are, as a rule, the appearance of muscle weakness or sensory disturbance, which is expressed in a feeling of numbness, and in addition, paresthesia in the lower extremities. Similar sensations after a few hours can spread to the upper limbs as well.
In some situations, the disease is accompanied by various pains in the lumbosacral region and muscles of the limbs. Less commonly, oculomotor disorders along with impaired phonation and swallowing are the first manifestation. The degree of motor impairment in Guillain-Barré syndrome varies significantly from slight muscle weakness to the development of tetraplegia. Paresis is usually symmetrical and more manifested in the lower extremities.
Hypotension
This syndrome, among other things, is characterized by hypotension along with a significant decrease or complete absence of tendon reflexes. Thirty percent of cases result in respiratory failure. The disorder of superficial sensitivity is manifested in the form of mild or moderate hyperkinesia according to the polyneurotic variant. Guillain-Barré syndrome after vaccination may occur.
About half of the patients experience deep sensitivity disorders. It happens that there is a complete loss of sensitivity. The lesions that are detected in most patients manifest themselves in the form of paresis of facial muscles, and in addition, bulbar disorders.
Among autonomic disorders, cardiac arrhythmia, arterial hypertension, sweating disorders, disorders of the digestive system and pelvic organs, which is accompanied by urinary retention, are most often observed.
Diagnosis
When collecting an anamnesis, it is necessary to pay attention to the presence of provoking factors, since in more than eighty percent of cases the development of this syndrome is preceded by certain pathologies and conditions.
We are talking about past infections of the digestive system and upper respiratory tract, including vaccination, surgery, intoxication and tumors. Neurological examination is aimed at identifying and assessing the severity of the main symptoms of Guillain-Barré syndrome during diagnosis.
Thus, experts evaluate sensitive, motor and autonomic disorder. As part of the diagnosis, a full clinical study is required:
- Delivery of a general analysis of urine, as well as blood.
- Submission of a biochemical analysis of blood, in the framework of which its gas composition is studied along with the concentration of serum electrolytes.
- Study of cerebrospinal fluid.
- Serological studies if there is a suspicion of an infectious etiology of the disease.
- Conducting electromyography. Its results are of fundamental importance for confirming the diagnosis and establishing the form of Guillain-Barré syndrome in children.
Daily pressure monitoring
In especially severe forms of the disease, when rapid progression with bulbar disorders is observed, daily monitoring of pressure and cardiogram of the heart is required along with pulse oximetry and examination of the function of external respiration.
As part of the confirmation of the diagnosis, progressive weakness should be noted in more than one leg or arm. Also, tendon reflexes (areflexia) should be absent. In the event that persistent pelvic abnormalities, a pronounced asymmetry of paresis and leukocytes along with a clear level of sensitivity disorder are observed, this should raise doubts about a diagnosis such as Guillain-Barré syndrome. In addition, there are a number of signs that completely exclude the diagnosis of the described disease, among them:
- Patient's recent diphtheria.
- Symptoms of lead intoxication or evidence.
- The presence of exclusively sensory impairment.
- Porphyrin exchange failure.
What kind of disease - Guillain-Barré syndrome - is now clear.
Differential diagnosis
First of all, a neurologist should differentiate this disease from other disorders that also manifest themselves as peripheral paresis, and in addition, other polyneuropathies. Against the background of acute intermittent porphyria, it is quite capable of resembling Guillain-Barré syndrome in its signs, but it is usually accompanied by a variety of psychopathological symptoms in the form of hallucinations and delusions, which are expressed by abdominal pain.
Thus, the symptoms of polyneuropathy are similar to the symptoms of the syndrome. The appearance of polyneuropathy is also likely with extensive cerebral strokes, followed by the development of tetraparesis, which takes on the features of a peripheral arteries. The main differences between myasthenia gravis and pathology are symptom variability along with the absence of sensitive disorders and changes in tendon reflexes.
Guillain-Barre Syndrome Treatment
All patients with this diagnosis must be hospitalized in a hospital in the intensive care unit. In approximately thirty percent of cases, due to the development of extreme respiratory failure, there is a need for ventilation of the lungs, the duration of which is determined individually. At the same time, doctors are guided by the restoration of the swallowing and cough reflex. The patient is disconnected from the ventilator gradually.
In severe forms of pathology development against the background of pronounced paresis, proper care is of particular importance for the prevention of any complications that are associated with prolonged immobility of patients. Such a patient requires a periodic change of position at least once every two hours. In addition, skin care is no less important along with monitoring the functions of the bladder and intestines, passive gymnastics and the prevention of aspiration. Against the background of persistent bradycardia with the presence of a threat of the development of asystole, the installation of temporary pacemakers may be necessary.
As a specific treatment for Guillain-Barré syndrome, aimed at stopping autoimmune processes, pulse treatment with class G immunoglobulins and plasmapheresis are currently used. The effectiveness of each of these methods is almost the same, in this regard, their simultaneous use is considered inappropriate. Membrane plasmapheresis can reduce the severity of paresis and the total duration of ventilation. For patients, as a rule, from four to six sessions are carried out with an interval of one day. As a replacement medium using a 0.9% solution of sodium chloride or dextran. Symptoms and treatment of Guillain-Barré syndrome are often interrelated.
It is necessary to take into account contraindications for plasmapheresis, which are various infections along with bleeding disorders and liver failure. In addition, the following complications are possible:
- The appearance of violations in the electrolyte composition.
- The development of hemolysis.
- The appearance of allergic reactions.
Class G immunoglobulin, as well as plasmapheresis, can reduce the length of stay of patients on mechanical ventilation. Immunoglobulin is administered intravenously for five days at a dose of 0.4 grams per kilogram of body weight daily. Possible side effects are nausea with headaches and muscle aches, as well as fever.
Symptomatic therapy for Guillain-Barré syndrome is carried out to correct violations of acid and water-electrolyte balance. Such treatment also allows you to normalize blood pressure, to prevent deep vein thrombosis and thromboembolism. The operation may be needed for tracheostomy in case of prolonged artificial lung ventilation for more than ten days. In addition, surgical intervention is done against the background of severe and prolonged bulbar disorders.
Clinical recommendations for Guillain-Barré syndrome should be strictly followed.
What is the forecast?
In most patients with the syndrome, complete recovery is observed within one year after proper treatment. Someone functional recovery is noted after six months. Persistent residual symptoms persist in approximately fifteen percent of cases. The relapse rate of this syndrome is approximately four percent.
With regard to mortality, it is five percent. Possible causes of death may be respiratory failure along with pneumonia or other infections and pulmonary thromboembolism. The immediate likelihood of a fatal outcome to a large extent depends on the age of the patient. So, among children under the age of fifteen, it, as a rule, does not exceed 0.7%, but in patients who are over sixty-five, this indicator approaches 8%.
Consider the main recommendations for Guillain-Barré syndrome.
Pathology Prevention
Specific methods aimed at preventing the disease, today do not exist. But it is necessary to notify patients about the ban on certain vaccinations during the first year after a disease. The fact is that any vaccination can cause a relapse of the disease. Subsequent immunization is permitted, but the validity of its need is required. In addition, the pathology that appeared within six months after any vaccination is a contraindication to this vaccine in the future.
What is it - Guillain-Barré syndrome - and the causes of the disease, we examined.