Guillain Barre Syndrome

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I picked up that next chart and saw the chief complaint was rash after taking prednisone. Sounded straight forward. The patient was a 16 year old female who looked like she was feeling fine and with no visible rash when I walked in the room. Her mother told me that after taking the prednisone she broke out in hives and so they gave her Benadryl, and now the rash was gone. Great, I thought, I love it when patients treat themselves appropriately. Nothing left for me to do but give her my blessing to go home. She looked fine and had a negative physical exam while laying on the gurney. On my way out the door I asked the patient's mother the reason she was taking Prednisone, was it because she has been have some type of recurrent rash? "No", she answered, "It is because she can't move." That stopped me in my tracks. Can't move? What does that mean? This question lead me down the rabbit hole. It turns out that the patient started having symptoms 2 weeks ago with extremity tingling and neck pain. She was seen in the ER and had neck x-rays which were negative and then followed up with her doctor and had an out patient MRI of her neck that was negative. She had her symptoms progress to weakness and cramping pain in her extremities. It did not seem to her that her symptoms were ascending but seemed to involve the proximal muscles of her hips and shoulders more then the distal muscles. The mother also told me that sometimes she would get facial symptoms with drooping eye lids or slurred speech. She told me that the longer she is up doing something the stronger she feels (as opposed to Myasthenia Gravis—where patients get weaker with repetitive movements) Her doctor started her on prednisone to see if it would help her symptoms because according to the mother he was worried that her symptoms were being caused by a virus. Her physical exam showed proximal muscle (MM) weakness. She could not sit up on her own, but once she was standing she could walk—but was somewhat off balance. She had to swing her legs around to the outside when she walked because of hip flexor weakness. Her cranial nerves were all intact except she had symmetric facial MM weakness and could not smile or puff out her checks. She could not smile or raise her eyebrows. Her reflexes were present 1+ hard to elicit bilateral biceps reflexes and 1-2+ bilateral patella reflexes. The interesting thing about her patella reflexes is that it seemed that there was a delay between when I would strike her knee and when it would move. It seemed to respond slowly. Almost the opposite effect of reflexes in severe hypothyroidism (where there is a delay in the relaxation phase). I could not get ankle reflexes. It turned out that this patient did in fact have Guillain-Barre syndrome (GBS). She had a high protein on her CSF tap during her hospitalization and was treated with IV IG. I thought that this would be a great opportunity to review Guillain-Barre and how it can present in children.

Channel: Howto & Style
Uploaded: May 22, 2007 at 7:06 am
Author: garythedo

Length: 0:04:42
Rating: 4.69
Views: 18,210

Tags: Guillain Barre Syndrome Emerency Medicine Department Letter

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Video Comments:
hippyhunter420 (Tuesday 12th of August 2008 01:19:29 AM)
GBS late 1999; 1500mg solumedrol I.V. for 3 days symptoms left 2 months later. This time my Dr. calls it Chronic Demyelinating Poly-Neuopathy)8 yrs later a variant is back but a less severe case this time...treatment has been 1000mg solumedrol I.V. for 5 days; Lyrica 75mg 3x day, and Immuran 50mg 2xday...the solumedrol sucks because it makes you break out and kills your sleep. The Lyrica is great because it really makes it feel as if you have zero symptoms.
copperowner (Sunday 27th of July 2008 08:05:16 PM)
My dad recently got out of the hospital from GBS. It was pretty scary because it came so quickly. He's getting better, but he still has to use a cane to walk and an eyepatch to help with his double vision.
garythedo (Sunday 27th of July 2008 09:48:15 PM)
Sorry to hear about your Dad, Hope that he continues to get better
mmc2482 (Monday 18th of August 2008 03:49:48 PM)
I am 25 and I had GBS back in January 2008, I had never heard of anyone else that suffered form the double vision. That was the last thing to go away and it was the most frustrating. I had a full recovery in about 2 1/2 months. Best of luck to your dad
py4god (Wednesday 23rd of July 2008 06:50:39 PM)
Very good doctor. I wonder how many M.D.'s are on Youtube? I do know that for doc's who haven't had much experience with GBS this would be helpful.
slightlyderanged (Wednesday 2nd of July 2008 06:15:28 PM)
I had GBS when i was 6 years old..i'm 21 now :)
huib2000 (Sunday 22nd of June 2008 05:50:39 PM)
Our daughter had GBS it was brought on by the flu shot, at first it looked like MS and went to see a MS specialist, but he didn't recognise the problem, it went away by itself, we only found out later what it was she had
bettyelvita (Tuesday 17th of June 2008 02:27:04 PM)
Excellent case study!! very informative for nurses students!! thanks!
PBcup90 (Monday 26th of May 2008 11:06:27 AM)
I was diganosed with GBS when I was eight years, lucky, I was treated early and I only had it for a couple or so weeks.
katey1dog (Tuesday 13th of May 2008 12:18:51 AM)
Thank you. This really explains what my girl friend has gone through in the past 10 years. She's doing great now, just has to remember she can't over do it. When she was in the hospital 10 years ago, she was on so much morphine that she was hallucinating and didn't know me. I was so afraid for her. But after some infusions and good diet and paying attention to her body symptoms she's been doing great. I'm so proud of her.