Post by annelieseRN on Mar 18, 2012 6:08:46 GMT -5
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Guillain-Barre syndrome is a serious disorder that occurs when the body's defense (immune) system mistakenly attacks part of the nervous system. This leads to nerve inflammation that causes muscle weakne
ss.
Causes, incidence, and risk factors
Guillain-Barre syndrome is an autoimmune disorder (the body's immune system attacks itself). Exactly what triggers Guil
lain-Barre syndrome is unknown. The syndrome may occur at any age, but is most common in people of both sexes between ages 30 and 50.
It often follows a minor infection, such as a lung infection or gastrointestinal infection. Most of the time, signs of the original infection have disappeared before the symptoms of Guillain-Barre begin.
The swine flu vaccination in 1976 may have caused rare cases of Guillain-Barre syndrome. However, the swine flu and the regular flu vaccines used today have not resulted in more cases of the illness.
Guillain-Barre syndrome damages parts of nerves. This nerve damage causes tingling, muscle weakness, and paralysis. Guillain-Barre syndrome most often affects the nerve's covering (myelin sheath). Such damage is called demyelination, and it causes nerve signals to move more slowly. Damage to other parts of the nerve can cause the nerve to stop working altogether.
Guillain-Barre syndrome may occur along with viral infections such as:
AIDS
Herpes simplex
Mononucleosis
It may also occur with other medical conditions such as systemic lupus erythematosus or Hodgkin's disease.
Some people may get Guillain-Barre syndrome after a bacterial infection. A similar syndrome may occur after surgery, or when someone is critically ill (neuropathy of critical illness).
Symptoms
Symptoms of Guillain-Barre can get worse very quickly. It may take only a few hours to reach the most severe symptoms, but weakness that increases over several days is also common.
Muscle weakness or the loss of muscle function (paralysis) affects both sides of the body. In most cases, the muscle weakness starts in the legs and then spreads to the arms. This is called ascending paralysis.
Patients may notice tingling, foot or hand pain, and clumsiness. If the inflammation affects the nerves to the diaphragm and chest and there is weakness in those muscles, the person may need breathing assistance.
Typical symptoms include:
Loss of reflexes in the arms and legs
Low blood pressure or poor blood pressure control
Muscle weakness or loss of muscle function (paralysis)
In mild cases, there may be weakness instead of paralysis
May begin in the arms and legs at the same time
May get worse over 24 to 72 hours
May occur in the nerves of the head only
May start in the arms and move downward
May start in the feet and legs and move up to the arms and head
Numbness
Sensation changes
Tenderness or muscle pain (may be a cramp-like pain)
Uncoordinated movement
Other symptoms may include:
Blurred vision
Clumsiness and falling
Difficulty moving face muscles
Muscle contractions
Palpitations (sensation of feeling the heart beat)
Emergency symptoms (seek immediate medical help):
Breathing temporarily stops
Can't take a deep breath
Difficulty breathing
Difficulty swallowing
Drooling
Fainting
Feeling light-headed when standing
Signs and tests
A history of increasing muscle weakness and paralysis may be a sign of Guillain-Barre syndrome, especially if there was a recent illness.
A medical exam may show muscle weakness and problems with involuntary (autonomic) body functions, such as blood pressure and heart rate. The examination will also show that reflexes, such as the "ankle or knee jerk," are decreased or missing.
There may be signs of decreased breathing caused by paralysis of the breathing muscles.
The following tests may be ordered:
Cerebrospinal fluid sample ("spinal tap")
ECG
Electromyography (EMG) tests the electrical activity in muscles
Nerve conduction velocity test
Pulmonary function tests
Treatment
There is no cure for Guillain-Barre syndrome. However, many treatments are available to help reduce symptoms, treat complications, and speed up recovery.
When symptoms are severe, the patient will need to go to the hospital for treatment, which may include artificial breathing support.
In the early stages of the illness, treatments that remove or block the proteins that attack the nerve cells, called antibodies, may reduce the severity and duration of Guillain-Barre symptoms.
One method is called plasmapheresis, and it is used to remove the antibodies from the blood. The process involves taking blood from the body, usually from the arm, pumping it into a machine that removes the antibodies, and then sending it back into the body.
A second method is to block the antibodies using high-dose immunoglobulin therapy (IVIG). In this case, the immunoglobulins are added to the blood in large quantities, blocking the antibodies that cause inflammation.
Other treatments are directed at preventing complications.
Blood thinners may be used to prevent blood clots.
If the diaphragm is weak, breathing support or even a breathing tube and ventilator may be needed.
Pain is treated with anti-inflammatory medicines and narcotics, if needed.
Proper body positioning or a feeding tube may be used to prevent choking during feeding if the muscles used for swallowing are weak.
Expectations (prognosis)
Recovery can take weeks, months, or years. Most people survive and recover completely. According to the National Institute of Neurological Disorders and Stroke, about 30% of patients still have some weakness after 3 years. Mild weakness may persist for some people.
A patient's outcome is most likely to be very good when the symptoms go away within 3 weeks after they first started.
Complications
Breathing difficulty (respiratory failure)
Contractures of joints or other deformity
Deep vein thrombosis (blood clots that form when someone is inactive or confined to bed)
Increased risk of infections
Low or unstable blood pressure
Paralysis that is permanent
Pneumonia
Skin damage (ulcers)
Sucking food or fluids into the lungs (aspiration)
Calling your health care provider
Seek immediate medical help if you have any of the following symptoms:
Can't take a deep breath
Decreased feeling (sensation)
Difficulty breathing
Difficulty swallowing
Fainting
Loss of movement
www.facebook.com/nclex.review.90
Guillain-Barre syndrome is a serious disorder that occurs when the body's defense (immune) system mistakenly attacks part of the nervous system. This leads to nerve inflammation that causes muscle weakne
ss.
Causes, incidence, and risk factors
Guillain-Barre syndrome is an autoimmune disorder (the body's immune system attacks itself). Exactly what triggers Guil
lain-Barre syndrome is unknown. The syndrome may occur at any age, but is most common in people of both sexes between ages 30 and 50.
It often follows a minor infection, such as a lung infection or gastrointestinal infection. Most of the time, signs of the original infection have disappeared before the symptoms of Guillain-Barre begin.
The swine flu vaccination in 1976 may have caused rare cases of Guillain-Barre syndrome. However, the swine flu and the regular flu vaccines used today have not resulted in more cases of the illness.
Guillain-Barre syndrome damages parts of nerves. This nerve damage causes tingling, muscle weakness, and paralysis. Guillain-Barre syndrome most often affects the nerve's covering (myelin sheath). Such damage is called demyelination, and it causes nerve signals to move more slowly. Damage to other parts of the nerve can cause the nerve to stop working altogether.
Guillain-Barre syndrome may occur along with viral infections such as:
AIDS
Herpes simplex
Mononucleosis
It may also occur with other medical conditions such as systemic lupus erythematosus or Hodgkin's disease.
Some people may get Guillain-Barre syndrome after a bacterial infection. A similar syndrome may occur after surgery, or when someone is critically ill (neuropathy of critical illness).
Symptoms
Symptoms of Guillain-Barre can get worse very quickly. It may take only a few hours to reach the most severe symptoms, but weakness that increases over several days is also common.
Muscle weakness or the loss of muscle function (paralysis) affects both sides of the body. In most cases, the muscle weakness starts in the legs and then spreads to the arms. This is called ascending paralysis.
Patients may notice tingling, foot or hand pain, and clumsiness. If the inflammation affects the nerves to the diaphragm and chest and there is weakness in those muscles, the person may need breathing assistance.
Typical symptoms include:
Loss of reflexes in the arms and legs
Low blood pressure or poor blood pressure control
Muscle weakness or loss of muscle function (paralysis)
In mild cases, there may be weakness instead of paralysis
May begin in the arms and legs at the same time
May get worse over 24 to 72 hours
May occur in the nerves of the head only
May start in the arms and move downward
May start in the feet and legs and move up to the arms and head
Numbness
Sensation changes
Tenderness or muscle pain (may be a cramp-like pain)
Uncoordinated movement
Other symptoms may include:
Blurred vision
Clumsiness and falling
Difficulty moving face muscles
Muscle contractions
Palpitations (sensation of feeling the heart beat)
Emergency symptoms (seek immediate medical help):
Breathing temporarily stops
Can't take a deep breath
Difficulty breathing
Difficulty swallowing
Drooling
Fainting
Feeling light-headed when standing
Signs and tests
A history of increasing muscle weakness and paralysis may be a sign of Guillain-Barre syndrome, especially if there was a recent illness.
A medical exam may show muscle weakness and problems with involuntary (autonomic) body functions, such as blood pressure and heart rate. The examination will also show that reflexes, such as the "ankle or knee jerk," are decreased or missing.
There may be signs of decreased breathing caused by paralysis of the breathing muscles.
The following tests may be ordered:
Cerebrospinal fluid sample ("spinal tap")
ECG
Electromyography (EMG) tests the electrical activity in muscles
Nerve conduction velocity test
Pulmonary function tests
Treatment
There is no cure for Guillain-Barre syndrome. However, many treatments are available to help reduce symptoms, treat complications, and speed up recovery.
When symptoms are severe, the patient will need to go to the hospital for treatment, which may include artificial breathing support.
In the early stages of the illness, treatments that remove or block the proteins that attack the nerve cells, called antibodies, may reduce the severity and duration of Guillain-Barre symptoms.
One method is called plasmapheresis, and it is used to remove the antibodies from the blood. The process involves taking blood from the body, usually from the arm, pumping it into a machine that removes the antibodies, and then sending it back into the body.
A second method is to block the antibodies using high-dose immunoglobulin therapy (IVIG). In this case, the immunoglobulins are added to the blood in large quantities, blocking the antibodies that cause inflammation.
Other treatments are directed at preventing complications.
Blood thinners may be used to prevent blood clots.
If the diaphragm is weak, breathing support or even a breathing tube and ventilator may be needed.
Pain is treated with anti-inflammatory medicines and narcotics, if needed.
Proper body positioning or a feeding tube may be used to prevent choking during feeding if the muscles used for swallowing are weak.
Expectations (prognosis)
Recovery can take weeks, months, or years. Most people survive and recover completely. According to the National Institute of Neurological Disorders and Stroke, about 30% of patients still have some weakness after 3 years. Mild weakness may persist for some people.
A patient's outcome is most likely to be very good when the symptoms go away within 3 weeks after they first started.
Complications
Breathing difficulty (respiratory failure)
Contractures of joints or other deformity
Deep vein thrombosis (blood clots that form when someone is inactive or confined to bed)
Increased risk of infections
Low or unstable blood pressure
Paralysis that is permanent
Pneumonia
Skin damage (ulcers)
Sucking food or fluids into the lungs (aspiration)
Calling your health care provider
Seek immediate medical help if you have any of the following symptoms:
Can't take a deep breath
Decreased feeling (sensation)
Difficulty breathing
Difficulty swallowing
Fainting
Loss of movement