Guillain Barre Syndrome

Dr. Allan Ropper discusses Guillain Barre Syndrome
Below are his responses to the questions in the chat box that we did not have time for him to answer.
Is it possible to have absent brainstem reflexes with GCS of 3 as a result of GBS? There are case reports in the literature; we had once a pt where we suspected this; he eventually succumbed and did not respond to IVIG
No-I think this is something else-maybe brainstem encephalitis. GBS is almost always a purely PNS disorder. I have seen a case of intravascular lymphoma cause a midbrain lesion and diffuse peripheral neuropathy.

Would you recommend doing MR whole spine with contrast to rule out other differentials?
No-the imitators are so rare that it should be possible to exclude them by exam--in cases of generalized paralysis always ask: "is the face affected?"

Is there any significant difference (longterm) in the disability between the axonal and the demyelinating types of Guillain Barre?
Yes--axonal has a bad prognosis or at least can take long to recover and left with some deficits. The prognosis in demyelinating is usually good but there are exceptions and some cases are mixed. they start demeylianting with prolonged distal motor latencies but there is denervation after a few weeks.

Can the biceps reflex be spared? and why?
It should not be spared if there are hand paresthesias (the same size fibers are in the large IA sensory nerves for large fiber sensation and the afferent reflex arc) . But almost any reflex can be spared in the first week.

If someone would ask you, what is cardinal for gbs to differenicate from myelopathy in shock stage especially if no sensory level?
Face weakness commensurate with limb weakness. Do you know about the recurrent bundle of Pick? There can be slight facial weakness in high cervical lesions but never severe.

Do you have any concern about a future vaccine against Covid-19 and the trigger of GBS?
Very little concern but we will have to see but no major concern. Any vaccination program will be followed by some GBS cases. Most will be background cases that would happen anyway during that period and some might be because of the immune configuration of the host. Even the famous 1976 swine flu vaccination program caused very few true post-vaccinal cases.