=====Guillain Barré Syndrome=====
  *inflammatory disease of the PNS and <wrap em>most common cause of acute flaccid paralysis</wrap>
  *typical presentation - weakness and sensory signs in legs progressing to arms and cranial muscles
  *clinical presentation is heterogeneous with several distinct clinical variants.
  *Disease progression can be rapid with most patients reaching maximum disability ≤2/52.
  *~20% develop respiratory failure and require mechanical ventilation
  *After initial progressive phase, most reach a plateau phase that can last from days to weeks or months, after which recovery follows
  *beware similarities with [[wiki:neurology:nentrapments#beriberi|Dry Beriberi]] so history is important

^<WRAP warning>10 step approach to Dx and Mx - an expert consensus 2019 </WRAP> ||
^<WRAP ROUND notice> Diagnosis </WRAP> ||
^1. When to suspect GBS  |• Rapidly progressive bilateral limb weakness +/- sensory deficits\\ • hypo/areflexia\\ • facial or bulbar palsy\\ • opthalmoplegia & ataxia  |
^2. How to diagnose GBS  |• check diagnostic criteria\\ • exclude other causes\\ • Consider - routine bloods, CSF exam, Electrophysiological studies  |
^<WRAP ROUND notice> Acute Care </WRAP> ||
|**3. When to admit to ICU**\\ one or more of:  |• Rapid progression of weakness\\ • severe autonomic or swallowing dysfunction\\ • Evolving resp distress\\ • EGRIS>4 (//Erasmus GBS Respiratory Insufficiency Score//)  |
|**4. When to start Rx**\\ one or more of:  |• inability to walk >10m independently\\ • rapid progression of weakness\\ • severe autonomic or swallowing dysfunction\\ • resp insufficiency  |
|**5. Treatment options**  |• IV immunoglobulin (0.4g/kg daily for 5/7)\\ • plasma exchange (200-250ml/kg for 5 sessions  |
|**6. Monitoring**  |• regular assessments of muscle strength, resp function, swallowing function, BP, HR/rhythm, bowel & bladder control  |
|**7. Early complications**  |• choking\\ • cardiac arrhythmias\\ • infections\\ • DVT\\ • dietary insuffiency, Hyponatraemia\\ • constipation, urinary retention\\ • compression neuropathy, limb contractures\\ • corneal ulceration, pressure ulcers\\ • depression, delirium  |
|**8. Clinical progression**  |• Treatment related fluctuation: repeat same Rx\\ • no initial response or incomplete: no evidence for repeating Rx  |
^<WRAP NOTICE ROUND>Long term care </WRAP>  ||
|**9. Predicting outcome**  |• calculate mEGOS (//modified Erasmus GBS Outcome Score//) on admission\\ • recovery can continue >3y after onset\\ • recurrence is rare (2-5%)  |
|**10. Rehabilitation**  |• start rehab early\\ • manage long term complaints (fatigue, pain, psychological)\\ • support with GBS organisations  |


==References include:==
[[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6821638/|Dx & Mx of Guillain Barre in 10 steps 2019]]\\