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12.7.09 RoseJones GBS

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  Guillain   -   Barre Syndrome December 7, 2009Lisa Rose   -   Jones, MD  GBS Eponym that encompasses acute immune   -mediated polyneuropathies   Peripheral nerve myelin is target of an   immune attackStarts at level of nerve root=conduction   blocks & muscle weaknessEventually get widespread patchy   demyel= increased paralysis  Pathophysiology Usually postinfectious   Immune   -   mediated: infectious agents thought to   induce Ab production against specific   gangliosides/glycolipids   Lymphocytic infiltration of spinal roots/peripheral   nerves & then macrophage   -   mediated, multifocal stripping of myelin   Result: defects in the propagation of electrical   nerve impulses, with eventual conduction block   and flaccid paralysis  Clinical Features: Progressive, fairly symmetric muscle   weakness-   typically starts in proximal legs   -   10% will 1   st   develop weakness in face or arms-   severe resp muscle weakness in 10   -30% pts-   oropharyngeal weakness in ~ 50%
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