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GBS vs CIP

OVERVIEW

  • GBS and CIP are important causes of weakness in ICU and distinguishing between them is important due to the management and prognostic implications
    • Guillain-Barré Syndrome (GBS)
    • Critical Illness Polyneuropathy (CIP)
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GBSCIP
History
  • Recent GI or resp illness.
  • Progressive bilateral symmetric paralysis.
  • Subtypes can be more localized e.g. MF ophthalmoplegia and ataxia.
  • Sensory involvement is common.
  • Areflexic.
  • Autonomic involvement may be present
  • Always occurs in association  with a critical illness in particular severe sepsis.
  • May have an association with encephalopathy in early stages.
  • It is a symmetrical weakness.
  • May have muscle tenderness, hyporeflexic, diminished distal sensation
  • Not associated with autonomic involvement
Examination
  • Albuminocytologic dissociation in CSF.
  • Identification of infection with campylobacter, mycoplasma, EBV,Varicella, CMV.
  • Elevated CSF IgG levels and possible serum antiganglioside antibodies
  • Elevated CK which may be transient.
Investigations
  • When demyelinating form is present, you get a reduction in conduction velocity as well as reduction in CMAP
  • In axonal forms however it is only the distribution of the findings that helps determine the diagnosis
  • Axonal neuropathy resulting in a decreased CMAP without a reduction in conduction velocity

CCC Neurocritical Care Series

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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