Fatores de pior prognstico
IDADE AVANADAINSTALAO RPIDA (< 7 dias)FRAQUEZA MUSCULAR GRAVE
NA ADMISSONECESSIDADE DE SUPORTE VENTILATRIOQUADRO DIARREICO
PRVIO
Guillain-Barr Syndrome (GBS) is an acquired disease of the
peripheral nervous system. Polineuropatia aguda imunomediadaThere
is considerable heterogeneity in the presentation and clinical
course. Further, variants of the disease have emerged to make GBS a
true syndrome rather than a specific disease.*Igual entre sexo
feminino e masculinoCausa.... Em qq idade*HeterogneoMais frequente
no ocidente aidpSndrome de Miller-Fischer variante de nervos
cranianos. Apresentao tpica com oftalmoplegia, ataxia e
arreflexia
*In the demyelinating form of the disease, macrophages penetrate
the basement membrane of Schwann cells and strip away the myelin
lamellae, leaving the axon exposed.
Bacteria may share antigenic sites with the axon, the peripheral
nerve myelin, or both.The most common form of GBS is AIDP, which is
characterized pathologically by demyelination, lymphocytic
infiltration, and macrophage-mediated clearance of myelin.
Approximately two thirds of GBS cases occur weeks after an
infection such as C. jejuni, CMV, Mycoplasma pneumonia, or
influenza virus. Theseinfectious agents have epitopes on their
surface that are similar to epitopes on the surface of peripheral
nerves (e.g., gangliosides, glycolipids), resulting in the
peripheral nerve acting as a molecular mimic of the infectious
agent.*Paralisia flcida ascendenteOs nervos cranianos podem ser
afetadosO nivel mximo de fraqueza atingido dentro de 4
semanas.CSFprotein normally peaks between 80 and 200 mg/dL at some
point during the illness. The constituents of the CSF protein are
similar to those of plasma, although gamma globulins with
oligoclonal bands may be present. The cell count rarely exceeds 10
lymphocytes/mm3. A finding of more than 50 cells/mm3suggests an
alternative diagnosis, as does a predominance of segmented
neutrophils.
Dissociao proteino-citolgica
*Em geral, ascendente, iniciando nos MMI, mas em 10% dos casos
pode comear nos MMSS ou na musculatura facialParestesias nas mos e
ps acompanham a paresia em 80% dos casos, mas as alteraes
sensitivas no exame fsico so discretas.*Tratamento modificador do
curso da doena Indicao: pacientes de perfil no-ambulatorial que se
apresentam dentro de 4 semanas com sintomas neuropticosOs pacientes
se recuperam mais rpido quando tratados precocemente*
