Guillian-Barr e Syndrome - A Case Study
Guillian-Barr e Syndrome - A Case Study
Guillian-Barr e Syndrome - A Case Study
Guillian-Barre Syndrome
a case study
C. E. Toft
Introduction
Cheryl E. Toft
R. N. (Adult)
Bachelor of Nursing
(Hons), Accident &
Emergency
Department,
St Marys Hospital,
Paddington,
London, UK.
Tel.: 0207 886 6401;
E-mail: Cheryl Toft
@hotmail.com
Pure Sensory
Guillian-Barre
Syndrome
Case study
Jane Smith presented to the department c/o of a
2-day history of numbness and tingling in her
feet and hands. This paraesthesia in a
stocking-glove distribution is a common
presenting symptom in GBS (McMahon-Parkes
& Cornock 1997) and can progress in an
ascending pattern to include legs, arms and
trunk.
These sensory deficits correlate with the
involvement of the afferent (sensory) fibres of
the spinal nerves in the demyelination process
of GBS. These nerve fibres usually convey
sensory information from the sensory receptors
in the skin, sense organs and viscera to the
central nervous system for interpretation and
initiation of a motor response, e.g. contraction
of muscle (Alexander et al. 1994). As it is the
heavily myelinated sensory nerves that are
affected, patients can also experience a
decreased appreciation of vibration and
proprioception (Murray 1993, Parobeck et al.
1992, Worsham 2000). A proportion of patients
do lose sense of touch, temperature and pain,
however, because the thinly myelinated nerves
(which support these sensations) are less
involved in the demyelination process, this is a
less common problem. As in Janes case, these
sensory symptoms usually recede and motor
symptoms become more prominent as the
condition progresses (Springhouse 1998). This
predominant motor pattern correlates with the
fact that GBS affects the more heavily
myelinated nerves which are involved in motor
function (McMahon-Parkes & Cornock 1997).
However, more recently, a possible variant of
the normal GBS pattern, which exhibits a more
prominent sensory involvement, has been
described (Giberman 1994).
Assessment of Janes sensory deficits were
carried out at regular intervals (through the
assessment of touch, pin prick and two point
discriminator) to assess the progression of the
disease.
One of the main complications of this
sensory deficit, which was experienced by Jane,
Deltoid
Biceps
C5, C6
C5, C6
Brachioradialis
Triceps
Knee
Ankle
C5, C6
C6, C7, C8
L2, L3, L4
S1, S2
Nerve tested
Circumflex nerve
Musculocutaneous
nerve
Radial nerve
Radial nerve
Femoral nerve
Sciatic nerve
Facial weakness/paralysis
Loss of smiling and frowining,
Difficulty closing eyes
Cranial Nerve IX
(Glossopharyngeal nerve)
Loss of taste
Difficulty swallowing
Cranial Nerve X
(Vagus nerve)
Cranial Nerve XI
(Accessory
nerve)
Loss of taste
Difficulty swallowing
Speech deficits due to paralysis
of the tongue
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Sensory
Parasthesia in extremities
Reduced proprioception
Sensory loss occurs in a stocking-glove
distribution
Hypertension, hypotension or labile
blood pressure
Tachycardia or bradycardia
Cardiac arrhythmias
Autonomic
Electromyography
Nerve Conduction
Studies
Table 8 Treatment of Guillian-Barre Syndrome (Winer 1994, Springhouse 1998, Meythaler 1997, McMahon-Parkes
& Cornock 1997)
Corticosteroid therapy
Used in the 1960s due to the belief that it would suppress the
autoimmune response in Guillian-Barre Syndrome
Controlled studies by Hughes et al. (1978) and the Guillian-Barre
Syndrome Steroid Trial Group (1993) found steroids to be
ineffective in speeding the recovery of patients
Plasmapheresis
Conclusion
This discussion of GBS has focused on the
pathophysiology of the condition and the effect
that the demyelination of the peripheral nerves,
has on the sensory, motor and autonomic
functions of the body. This condition has the
potential to result in death through the
paralysis of the respiratory muscles and
autonomic disruption leading to cardiovascular
complications. GBS remains a mystery with an
unknown aetiology and no cure. Therefore
treatment remains supportive, through the
monitoring of deterioration, control of
symptoms and prevention of complications.
Nurses should be aware of the pathophysiology
of this condition and the effect that it has on the
organs and tissues within the body so as to be
able to provide a high standard of care and
ensure that timely, life-saving interventions are
initiated. Possibly the most challenging aspect
of nursing care is providing patients, who have
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