With respect to the Guillain Barre Syndrome (GBS):
GBS |
CIP |
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History and |
Recent GI or resp illness. |
Always occurs in association with a critical illness in |
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Investigations |
Albuminocytologic dissociation in CSF. |
Elevated CK which may be |
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Nerve |
When demyelinating form is |
A axonal neuropathy resulting in a decreased |
b)
c)
The distinctions between GBS and CIPN:
As for management, Oh's Manual recommends either plasma exchanges or IV immunoglobulin, but there is no benefit in giving both together.
A discussion of the approach to the ICU patient with generalised weakness is available elsewhere.
A generic exam-oriented approach to Guillain Barre syndrome is presented in the "Required Reading" section.
An even better table than the CICM college answer is available in this 2006 article fom Respiratory Care; it is reproduced below.
Critical illness polyneuropathy |
Guillain-Barre |
Critical Illness Myopathy |
|
Clinical setting |
Sepsis Septic encephalopathy |
Antecedent viral illness Surgery Campylobacter jejuni HIV |
Neuromuscular blocking drugs Corticosteroids Asthma Organ transplant |
Motor weakness |
Generalised and distal |
Generalised and ascending |
Generalised and proximal |
Reflexes |
Diminished |
Absent |
Preserved but weak |
Cranial nerve palsy |
Rare |
Common |
Absent |
Dysautonomia |
Normal autonomic function |
Frequent dysautonomia |
Normal autonomic function |
Sensory deficit |
Distal |
Normal sensation, or slightly altered |
Normal sensation |
CK level |
Normal |
Normal |
Elevated |
Nerve conduction |
Reduced CMAP and SNAP amplitude (compound muscle action potentials and sensory nerve action potentials) |
Marked slowing, conduction block |
Reduced CMAP amplitude |
Needle EMG |
Abnormal spontaneous activity Reduced recruitment Large polyphasic motor unit potentials (MUPs) |
Abnormal spontaneous activity Reduced recruitment Normal MUPs (early in disease) |
Minimal spontaneous activity Early recruitment Small polyphasic MUPs; |
Direct muscle stimulation |
Normal |
Normal |
Absent or reduced |
Muscle biopsy |
Neuropathic changes |
Neuropathic changes |
Myopathic changes Thick myosin filament loss Muscle fiber necrosis |
Chapter 51 (pp. 568) Acute cerebrovascular complications by Bernard Riley and Thearina de Beer
Chapter 57 (pp. 617) Neuromuscular diseases in intensive care by George Skowronski and Manoj K Saxena
Yuki, Nobuhiro, and Hans-Peter Hartung. "Guillain–Barré syndrome." New England Journal of Medicine 366.24 (2012): 2294-2304.
Jani, Charu. "Critical Illness Neuropathy." Medicine (2011): 237.
Dhand, Upinder K. "Clinical approach to the weak patient in the intensive care unit." Respiratory care 51.9 (2006): 1024-1041.