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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
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Gullian barre syndrome

Apr 21, 2017

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Page 1: Gullian barre syndrome

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

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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.

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ETIOLOGY

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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

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Pathophysiology of Gullian-Barre

Syndrome

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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

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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

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Sign of Gullain-Barre Syndrome

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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)

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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)

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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

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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)

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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)

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SYMPTOMS

OF GULLIAN-BARRE SYNDROME

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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).

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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).

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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).

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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

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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

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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

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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.

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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.

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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.

pdf

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

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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.

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Nuerology, 55(11). Retrieved from

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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.

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Pieter, A. D., Liselotte R., & Bart C. J. (2008). Clinical features,

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Neurology. Retrieved December 24, 2012, from

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Avraham U., Joab C., Yehuda S., (2012). Guillain-Barr´e syndrome. In

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Autoimmune Diseases, (pp219-223). Lengerich: Pabst Science

Publishers

WebMD. (2010). Brain & Nervous System Health. Retrieved December

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symptoms.

Tauqeer H. (Ed.).(2010). Guillain Barre Syndrome, Symptoms,

Diagnosis and Treatment. Retrieved from December 24, 2012, from

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diagnosis-and-treatment-3b893de803b.html .