I. Diagnostic criteria.
1. Weakness of the walking limbs, basically symmetrical, and a few may be asymmetrical. In mild cases, the lower limbs are weak, and in severe cases, the limbs are paralyzed, including trunk paralysis, ball palsy, facial muscle and even extraocular muscle paralysis, and the most serious one is respiratory muscle paralysis.
2. The reflexes are weakened or disappeared, especially the distal ones are often gone.
3, the disease is rapid, the disease is progressive aggravation, often in a few days to 1-2 weeks to peak, to 4 weeks to stop the development, stable into the recovery period.
4, more complaints of sensory disorders, objective examination is relatively light, may present glove, sock-like sensory abnormalities or no obvious sensory disorders, a few have sensory hypersensitivity, nerve trunk pressure pain.
5, nerve to the linguopharynx, vagus, sublingual nerve involvement is common, other cranial nerves can also be damaged, but the optic and auditory nerves are almost not involved.
6, Combined vegetative nerve dysfunction, such as tachycardia, hypertension, hypotension, vasomotor disorders, sweating, and may have momentary difficulty in urination.
7.About half of the first 1-6 weeks have respiratory and intestinal infections, unexplained fever, chickenpox, herpes zoster, mumps, mycoplasma, malaria, rain, cold, fatigue, trauma, surgery, etc.
8.The recovery period enters 2-4 weeks afterwards, or it can be delayed to several months before the recovery starts.
9, spinal fluid examination: WBL <10×106/L, 1-2 weeks, protein may be elevated, showing protein-cell separation (if cells exceed 10×106/L, predominantly multinucleated, other diseases need to be excluded), cytological classification is predominantly lymphoid mononuclear cells, and a large number of phagocytes may also appear.
10, physiological examination: after the disease, there may be a significant slowdown of nerve conduction, and the F wave reflects the slowdown of proximal nerve trunk conduction.
Clinical typing
1.Type: the muscle strength of the limbs is above grade III and can walk independently.
2.Type: the muscle strength of all four limbs is below grade III, and cannot walk.
3, type: IX, X and other cranial nerve paralysis, unable to swallow, along with limb weakness to paralysis, mild respiratory distress when moving, but not requiring tracheotomy and artificial respiration.
4, Heavy: In a few hours to 2 days, the development of tetraplegia, swallowing can not, respiratory muscle paralysis, must be immediately tracheotomy, artificial respiration, with severe cardiovascular dysfunction or explosive type also merged into this type.
5, hairstyle: several months (4-6 months) to more than 10 years can have multiple recurrences, light and heavy as the above symptoms, should pay extra attention. Often heavier than the first, can be from light to very heavy symptoms.
6. Sexual or chronic inflammatory demyelinating polyneuropathy: slow onset from 2 months to several months or even years, persistent, with little cranial nerve damage, significant muscle atrophy of the extremities, and persistent increase in cerebrospinal fluid protein.
7. Heterotypes: pure motor GBS; sensory GBS; multicranial nerve GBS; pure total vegetative neurological insufficiency GBS, other than Fisher syndrome, a few GBS with transient pyramidal fasciculations and GBS with cerebellar ataxia, etc.
Differential diagnosis
The disease should be differentiated from the following diseases
(1) poliomyelitis.
(2) Acute myelitis.
(3) hypokalemic paralysis.
(4) peripheral neuritis (peripheral neuritis)
(5) polymyositis.
(6) porphyria with peripheral neuropathy.
IV. Treatment
1. Comprehensive treatment and care: Keeping the respiratory tract unobstructed and preventing secondary infection is the key to treatment. If the swallowing muscles and respiratory muscles are involved, coughing is weak and sputum discharge is poor, tracheotomy and ventilator-assisted breathing are necessary; strengthen care, turn more often to prevent decubitus ulcers; protect the cornea and prevent ulcers in facial paralysis. Because the disease can be combined with myocarditis, the heart should be closely observed, and the amount of rehydration is not easy to be too large.
2, hormone: the application is controversial, can be applied for a short time early, the course of treatment should not be too long, generally in about 1 month, acute severe cases can be short-term shock treatment, hydrocortisone 5-10mg/kg.d or dexamethasone 0.3~0.5mg/kg.d.
3, high-dose gammaglobulin intravenous application: 400mg/kg.d for 5 days. It should be used as early as possible, but it is more expensive.
4.Plasma exchange therapy: It is a new treatment carried out in recent years and is initially considered effective, but requires special equipment and is expensive.
5.Appropriate application of neurotrophic drugs: such as coenzyme A, ATP, cytochrome C and other metabolic drugs, can also be applied at the same time vitamin B12.