Since I don't want to overpressure my 'rubber bands' I'm going to limit today's battles to
MRCP revision battle 11.1: Guillain Barre Syndrome
MRCP revision battle 11.2: Miller Fisher Syndrome
MRCP revision battle 11.3: Syringomyelia
MRCP revision battle 11.4: Kallmans
MRCP revision battle 11.5: Carcinoid Syndrome
MRCP revision battle 11.1: Guillain Barre Syndrome
Guillain Barre Syndrome is a rare, post-infective demyelinating polyneuropathy.
It tends to occur a few weeks after 'the flu' or a minor illness. The most commonly associated pathogens are:
- campylobacter jejuni
- mycoplasma
- CMV
- EBV
- HIV
- zoster
Guillain Barre Syndrome is characterised by an ascending, symmetric muscle weakness. Proximal muscles are more affected than distal ones. Cranial nerves may also be involved, with CN VII being the most common.
There is usually a 'progressive' phrase for around 4 weeks, after which the patient starts to improve.
Features associated with GBS that appear in MRCP questions include:
- papilloedema
- urinary retention
- arrhythmias
Diagnostically GBS is characterised by:
- very high protein in CSF
- decreased nerve velocity on EMG
- areflexia
The prognosis for patients with GBS is worse if:
- rapid onset of symptoms
- older age
- axomal neuropathoes
- preceeded by campylobacter infection
Management is:
- 4 hourly FVC, to check the patient's respiratory muscles aren't affected
- ventilation if needed
- plasma exchange
- IV IG
Overall, 85% of patients make a complete/new complete recovery.
10% will relapse
Less than 5% will die.
Now to to meet a close relative of GBS, Miller Fisher Syndrome.