GuillainBarre Synd格林巴利英文课件.ppt

Guillain-Barre Syndrome William Woodfin MD K.F. 40 y.o. r/h woman 3/17 Nausea, diarrhea severe myalgias Son dxed c rotavirus 1 wk. Previously 4/21 “Creepy-crawlies” legsarms 4/25 Weakness legs progressing 4/26 Handwriting looks like “hen scratch” K.F. 40 y.o. woman 4/28 Admitted to outside hospital. L.P. wnl EMG positive waves in some leg muscles NCVs absent H-reflexes F responses motor latencies wnl K.F. 40 y.o. woman 4/29 Transferred to PHD Hx.: diabetic x 10 yrs. hypothyroid- treatedx yrs. no sphincter disrubance aching pain low back buttocks mild postural light headedness no SOB or palpatations Exam BP 150/90 P 80 Wt. 250 lbs. Mild weakness neck flexors 4/5 biceps, grip interossei- symmetric 2/5 iliopsoas quadriceps 3/5 hamstrings adductors 4/5 abductors 4/5 ankles toes- extensors flexors Exam Sensory- intact DTRs- biceps, BR, knees are trace c reinforcement. Triceps ankles unobtainable Plantars- flexor F to N- intact Gait- not testable Lab H/H 10.3/33.5 c microcytic indices A1c Hgb 10.1 TSH 0.97 LDL 182 Serum immunofixation- wnl. No IgA def. FVCs- consistently 4+ liters MRI LS spine s c contrast- no nerve root enhancement Course in hospital Treated c IVIG 0.4 gms/kgm daily x 5 Strength fluctuated only mildly Blood sugars ok in AM, high in afternoons Repeated NCVs show mild dispersion of F waves Transferred back to referring hospital 5/6 Telephone FU Ambulating fairly well c walker. Strength clearly improving. Still bothered by “creepy-crawlies” What is the GBS? Due to the breadth of clinical presentation it is of limited help to try to define rigid diagnostic criteria. Thomas Munsat 1965: “…The GBS is easy to diagnose but difficult to define The typical illness evolves over weeks usually following a