Guillain-Barre, also called Guillain-Barre syndrome, is a syndrome characterized by nerve root and peripheral nerve damage accompanied by protein-cell separation in the cerebrospinal fluid. Patients may experience severe burning-like pain and involvement pain, which seriously endangers their physical and mental health. Knowing the early symptoms of Grimbali can effectively provide early treatment, alleviate the torment of the disease and avoid deterioration of the condition.
To this end: experts from Xinjiang Biological Cell Therapy Center have introduced the early symptoms of Grinbarrhea, hoping that patients can be alert when these symptoms appear.
Early symptoms of Guillain-Barre
Movement disorders: the main symptom of Grinbaris is muscle paralysis of the limbs and trunk. It usually starts from the lower limbs and gradually spreads to the trunk muscles, both upper limbs and cranial nerves, and can go from one side to the other. The disease usually progresses to its peak within 1 to 2 weeks. The paralysis is usually more proximal than distal, with hypotonia. If respiration, swallowing and pronunciation are involved, it can cause life-threatening paralysis of autonomic respiration, difficulty in swallowing and pronunciation.
Sensory impairment: generally mild, mostly starting from numbness and pins and needles sensation at the end of the limbs. There may also be garter-like sensory loss, disappearance or hypersensitivity, as well as spontaneous pain, with pressure pain evident in the gastrocnemius and anterior wall muscle angles. Occasionally, segmental or conduction bundle sensory deficits are seen.
Cranial nerve symptoms: Half of the patients have cranial nerve damage, with peripheral paralysis of the tongue, pharynx, vagus nerve and one or both facial nerves being more common. This is followed by motoneurosis, talipes, and abducens nerve. Occasionally, edema of the optic nerve papillae is seen, which may be due to inflammatory changes in the optic nerve itself or cerebral edema, or may be related to a significant increase in cerebrospinal fluid proteins that block the arachnoid villi and affect cerebrospinal fluid absorption. Diagnosis of the disease is based on the sudden appearance of symmetrical distal sensory, motor and nutritional disorders of the extremities and loss of tendon reflexes after infectious diseases.
Fourth, plant nerve dysfunction: the initial or recovery period is often sweaty, sweat odor is strong, may be the result of sympathetic nerve stimulation. A few patients may have short-term urinary retention at the beginning, which can be caused by temporary dysfunction of the vegetative nerves innervating the bladder or damage to the spinal nerves innervating the external extensor muscles; stools are often constipated; some patients may have unstable blood pressure, tachycardia and electrocardiogram abnormalities.
V. Reflex disorders: tendon reflexes of the extremities are mostly symmetrically weakened or disappeared; abdominal wall and testicular reflexes are mostly normal. A few patients may develop pathological reflex signs due to vertebral fasciculus involvement.
Causes of Guillain-Barre syndrome
1, When suffering from diabetes, uremia, hematoporphyria, gout and other such diseases, metabolic and endocrine disorders will appear, thus becoming the cause of Greenbrier syndrome.
2. Systemic lupus erythematosus, polyarteritis nodosa, scleroderma, and other connective tissue diseases can also cause Guillain-Barre syndrome.
3, when suffering from infectious diseases: such as leprosy, brucellosis, influenza, measles, diphtheria, etc., which is also the cause of the Greenbarrier syndrome. 4, if some chemical w substances and goods poisoning, also will appear Greenbarrier syndrome symptoms, such as: carbon monoxide, carbon disulfide, carbon tetrachloride, and some heavy metals.
5, when the body’s nutritional deficiencies, foot disease, pellagra, vitamin B12 deficiency or chronic alcoholism, will become the cause of the Greenbrier syndrome.
6. Infection, heredity, and progressive hypertrophic polyradiculoneuritis can lead to the cause of Greenbrier syndrome.
How to prevent Greenbrier syndrome?
1. Learn to eat scientifically and prevent dietary disorders
The dietary condition of Greenbrier syndrome has a certain relationship with the occurrence of impotence. If you are hungry and have chronic malnutrition, your limbs and muscles will be deprived of water and nutrients and will become impotent. If you eat thick and fatty food without transportation, you will become impotent due to the stagnation of spleen and dampness and the relaxation of tendons and veins. Therefore, the prevention of impotence, must do a reasonable diet, and taste, avoid bias, according to the amount of time, to five grains for nourishment, five dishes for the full, five fruits for the help, five animals for the benefit, strictly prohibit over-eating five flavors, especially food not too salty. Both the intake of adequate protein and fat, but also to prevent wanton eating sorghum thick taste, avoid hunger and satiety is not normal, unclean diet, wanton eating raw and cold. Usually to quit smoking light tea, drinking alcohol when appropriate, not too much.
2.Strengthen physical exercise to keep the blood flowing smoothly
Patients with Guillain-Barre syndrome often participate in a certain amount of physical exercise, can make the circulation of blood, joint sparing, strong muscles, developed muscles, limbs
The activity is strong, and the function of the internal organs is strong, so that impotence does not occur. Therefore, to develop good sports habits, often do gymnastics, play taijiquan, practice ‘five birds play’, eight duanjin, as well as running, playing ball, etc., all have positive significance for the prevention of impotence.
3, usually pay attention to safety, avoid accidental injury
Accidents often bring misfortune, falls, falls and other injuries are often easy to damage the internal organs and bones, meridians and blood, resulting in limbs atrophy and useless. Therefore, life must have a sense of security, do not fetish carelessness, take it lightly. Especially in today’s industrialized and crowded cities, it is important to pay attention to work safety and traffic safety to avoid traumatic accidents.
Precautions for patients with Guillain-Barre
1.Strengthen aspiration, oxygen administration, turning, back patting and coughing up sputum.
2.Lungs are racked to avoid aggravating respiratory distress, and tracheotomy kits and utensils are prepared.
3, closely observe the change of condition, once the respiration is aggravated, sputum is not smooth, severe hypoxia, immediately report to the doctor and prepare for tracheotomy. After the operation, the patient should be cared for according to the nursing routine after tracheotomy.
4.Psychological care: The patient is conscious, often irritable, nervous, and uncomfortable because of difficulty in breathing, coughing up sputum and turning. Provide more comfort and encouragement, help turning and coughing up sputum, and enhance confidence in overcoming the disease.
5. Strengthen respiratory care: The safety of these patients often depends on the good or bad respiratory function and the presence or absence of pulmonary complications, so early prevention is very important.
Guillain-BarreSnydrome (GBS) is a common and frequent disease. It refers to an acute onset, group of autoimmune diseases of the nervous system. The syndrome is characterized by nerve root and peripheral nerve damage with protein-cell separation in the cerebrospinal fluid. It is also known as Guillain-Barre syndrome. It can affect both men and women at any age, but is more common in young and middle-aged men.
Depending on the form and course of the disease, GBS can be divided into acute, chronic relapsing, and chronic progressive forms. Acute Guillain-Barre syndrome is also known as acute infectious polyradiculoneuritis or acute infectious demyelinating polyradiculoneuropathy (AIDP). More than half of the patients have a history of infection in the days to weeks before onset, such as upper respiratory tract infection with sore throat, nasal congestion, fever, and gastrointestinal symptoms such as diarrhea and vomiting, as well as shingles, influenza, chickenpox, mumps, and viral hepatitis. The onset of the disease is usually rapid, with symptoms gradually worsening and reaching a peak within 1-2 weeks.
More than 80% of patients first experience weakness of both lower limbs, followed by a gradual increase in paralysis. In severe cases, quadriplegia and respiratory paralysis occur and endanger life. Most patients start to recover in 2-4 weeks, and the degree and speed of recovery varies greatly from patient to patient. About 1/3 of patients may have residual symptoms. For example, weakness or muscle atrophy of both lower or/and upper extremities, muscle pain, and foot drop. Subjective sensory abnormalities, such as numbness, ankylosis, pins and needles, and burning sensation in the affected extremities, and a “glove-stocking” type of sensory loss or absence in the distal extremities can be seen on examination. Some patients may have facial palsy, dysphagia, dysarthria, choking and inability to cough up sputum. In some patients, vegetative dysfunction can be seen as little or excessive sweating of the hands and feet, dry skin on the extremities, or urinary or fecal retention or incontinence.
Chronic Guillain-Barre syndrome is also known as chronic infectious demyelinating polyradiculoneuropathy (CIDP). CIDP is similar to AIDP but differs in that it has a slow, relapsing course and is characterized by muscle weakness and sensory disturbances. The symptoms of muscle weakness are often symmetrical, mainly in the shoulders, upper arms and thighs, but can also be combined with weakness in the forearms, lower legs, hands and feet, and limb weakness is often more common than trunk weakness. Lower extremity weakness is often manifested as stumbling, easy to step on air, unable to stand for long periods of time, difficulty in going up and down stairs and difficulty in sitting up. Upper extremity weakness is characterized by difficulty in opening locks with keys, holding pens, unbuttoning, and combing hair. Most of the muscles have atrophy. A significant number of patients have a rapid deterioration of the clinical manifestation of the disease, from the distal extremity muscle atrophy progressively to the proximal end, and even involving the chest and back, neck muscle groups, resulting in generalized muscle atrophy; worse, it rapidly leads to respiratory muscle atrophy, clinical manifestations of respiratory distress, patients due to respiratory failure, heart failure and life-threatening. Clinical manifestations
The clinical manifestation of Guillain-Barre syndrome is generally based on the sudden appearance of severe nerve root pain (more in the lumbar shoulder, neck, and lower limbs), acute progressive symmetrical limb weakness, subjective sensory impairment, and weakened or absent tendon reflexes 1~3 weeks after the infectious disease. The specific manifestations are.
(1) Sensory impairment: generally mild, mostly starting from numbness and pins and needles sensation at the ends of the limbs. There may also be hyperalgesia, hypersensitivity or loss of garter-like sensation, as well as spontaneous pain, with pressure pain evident in the anterior wall muscle angle and gastrocnemius. Occasionally, segmental or conduction bundle sensory deficits are seen.
(2) Motor disorders: muscle paralysis of the extremities and trunk is the most important symptom of the disease. It usually starts from the lower extremities and gradually spreads to the trunk muscles, both upper extremities and cranial nerves, and can go from one side to the other. The disease usually progresses to its peak within 1 to 2 weeks. The paralysis is usually more proximal than distal, with hypotonia. If respiration, swallowing and pronunciation are involved, it may cause life-threatening paralysis of autonomic respiration, difficulty in swallowing and pronunciation.
(3) Reflex disorders: tendon reflexes of the limbs are mostly symmetrically weakened or disappeared, and abdominal wall and raphe reflexes are mostly normal. A few patients may develop pathological reflex signs due to vertebral fasciculus involvement.
(4) Plant nerve dysfunction: there is often excessive sweating and strong sweat odor in the initial or recovery period, which may be the result of sympathetic nerve stimulation. A few patients may have short-term urinary retention at the initial stage, which can be caused by temporary dysfunction of the vegetative nerves innervating the bladder or damage to the spinal nerves innervating the external dilator muscles; stools are often constipated; some patients may have unstable blood pressure, tachycardia and abnormal electrocardiogram, etc.
(5) Cranial nerve symptoms: Half of the patients have cranial nerve damage, with peripheral paralysis of the tongue, pharynx, vagus nerve and one or both facial nerves being the most common. This is followed by motoneuria, talipes, and abducens nerves. Occasionally, edema of the optic nerve papillae is seen, which may be due to the optic nerve itself
This may be due to inflammatory changes in the optic nerve itself or cerebral edema, or it may be related to a significant increase in cerebrospinal fluid proteins that block the arachnoid villi and affect cerebrospinal fluid absorption. The diagnosis of the disease is based on the sudden onset of symmetric sensory, motor and nutritional deficits in the distal extremities and loss of tendon reflexes following infectious disease. Etiology and pathogenesis
The etiology and pathogenesis of Guillain-Barre syndrome have not been fully elucidated yet, but it is generally believed that it is a delayed allergic immune disease caused by a history of nonspecific infection and vaccination prior to the onset of the disease. There is an incubation period between the onset of infection and the onset of the disease. The immune response acts on the Schwann cells and myelin sheath of the peripheral nerves, producing limited segmental demyelination with perivascular and intimal infiltration of lymphocytes, monocytes and macrophages.
In severe cases, axonal degeneration and fragmentation are seen. Myelin sheaths can regenerate, and both myelin loss and regeneration can be seen in the same nerve fiber. Inflammatory reactions of the spinal membrane, punctate hemorrhage of the spinal cord, degeneration of the anterior horn cells and motor nuclei of the cranial nerves are sometimes seen. The muscles show denervated atrophy.
The clinical signs are a history of upper respiratory or gastrointestinal tract infection or vaccination 1-4 weeks prior to the onset of the disease. The disease can develop in all seasons, but is more common in summer and autumn.
According to Chinese medicine, Grimballi syndrome belongs to the category of “impotence”. Its cause is mostly due to summer heat and dampness; the pathogenesis is that dampness and heat invade the meridians and tendons, and the liver, kidneys, and spleen are slowed down, resulting in loss of essence and blood, and muscle and tendon disorders. Prevention
In Chinese medicine, this disease still belongs to the category of “impotence”. To prevent Greenbaric syndrome, we should do the following as much as possible.
First, be careful to adapt to the climate and to avoid the problem of sexual intercourse
The occurrence of impotence is often related to the carelessness of one’s own intake. The six evil spirits, such as moisture, cold, heat, and summer heat, take advantage of the opportunity to enter the body and attack impotence, and modern medicine blames bacterial and viral infections. Therefore, the prevention of impotence must be in line with the four seasons of climate change, cold to keep warm, to avoid heat, and to prevent moisture. The room should be clean and dry, ventilated and light, and when you go out, you should pay attention to the cold and temperature of the climate and increase and decrease your clothes appropriately to prevent colds. In particular, avoid lying on wet ground or wet by the rain, avoid sweating after wet clothes for a long time on the body. Long-term work in the water, or in the year too much soil, dampness, as well as the long summer season, more attention should be paid to prevent dampness invasion, and the development of impotence.
Second, the parents are strong in essence and blood, strong innate endowment
The occurrence of impotence can be caused by both acquired factors and congenital factors. Such as progressive muscular dystrophy and other similar impotence evidence, are related to heredity. Therefore, for the prevention of impotence, is the parent’s essence and blood in abundance? What is their physical condition? Are there any genetic disorders? Are they suitable for marriage? These are all crucial factors. Only if the parents are full of essence and blood, have strong bodies and no hereditary diseases, and their children are naturally endowed with good hair, can the occurrence of impotence be avoided. Therefore, it is important to prevent impotence, not only to take care of oneself, but also to blame the parents.
Third, pay attention to the caution of sexual intercourse, to avoid the loss of kidney essence
The impotence evidence is an important reason for the formation of impotence. As Su Wen? Impotence Theory” points out: “endless thoughts, what you want can not be, intentional lust outside, people room too much, zong tendon relaxation, the development of tendon impotence.” Therefore, to prevent impotence, it is important to abstain from sexual desire and protect the essence, and to be cautious of sexual intercourse and not to overdo it. The scientific sex life, should be in late marriage, the room has a degree, together with the room has the art. 20-29 years old between people, every 4 days to have a room, 30-39 years old between people, every 8 days to have a room, 40-49 years old between people, every 16 days to have a room, 50-59 years old between people, every 20 days to have a room, after 60 years old, it is best to cut off the room. If the physical strength is strong, can be 1 time a month. At the same time, we should know the taboos of human room: do not perform intercourse after drinking, bad mood, physical fatigue, abnormal climate, avoid the abuse of aphrodisiac drugs, stimulate sexual desire to force intercourse, in order to protect the kidney essence, to avoid the development of impotence.
Prescriptions for the treatment of Green-Barre syndrome.
1. Grin-Barre I formula
Composition and usage: Astragalus membranaceus 30g, Astragalus membranaceus, Gynostemma spp. 12g, Radix et Rhizoma pseudostellariae, Fructus Lycii, Radix et Rhizoma spp. 10g, Radix et Rhizoma spp. 5g, Radix et Rhizoma saffron, Radix et Rhizoma scorpion 5g, Radix et Rhizoma strychnine in oil 0.1g-0.3g, Radix et Rhizoma glycyrrhiza 3g, Radix centipede 1. Decoction with clean water, 1 dose daily.
Useful Remarks: Benefit Qi and clear heat, activate blood circulation. In this formula, Astragalus membranaceus tonifies qi and strengthens the coup, invigorates the middle state; Huang Jing moistens the lung and nourishes yin, tonifies the spleen and benefits qi; Yin Hua and Da Qing Ye clear heat and detoxify to dispel evil; Fructus Lycii, Fructus Parviflora and Xian Ling Spleen tonify the liver and kidney, fill in the marrow; Ge Ge Gen elevates yang and benefits the stomach, nourishes the tendons and unblocks the ligaments; Xanthopia, Safflower, Scorpion and Centipede invigorate the blood and open the ligaments; Strychnine in oil is used to open the ligaments and relieve pain and excite the Governor’s Vessel. A small amount of strychnine can release the inhibition of motor neurons by counteracting the release of glycine from Renshaw cells, which can excite the spinal cord and increase the tone of skeletal muscles, and has the effect of exciting the medulla oblongata and the brain. The combination of these drugs is clinically effective in the acute stage of this disease.
2.Added flavor Ermiao San
Composition and Usage: Atractylodes macrocephala 6g, Cyperus rotundus 6g, Serenoa serrata 6g, Rhizoma Dioscorea 12g, Papaya 15g, Coix seed 15g, Panax notoginseng 15g, Fu Ling 20g, Mouton 5g. 1 dose daily, decoction with water, divided into 2 doses.
Effects: Clearing heat and drying dampness, soothing tendons and relieving paralysis. In this formula, Atractylodes Macrocephala and Phellodendron are used to clear heat and dry dampness; Silkworm dispels wind and dampness, activates blood circulation; Dioscorea dispels wind and relieves dampness and paralysis; Papaya relieves dampness and invigorates tendons; Coix Seed strengthens the spleen and permeates dampness; Panax notoginseng and Tu Fu Ling clear heat and detoxify toxins; Moutong clears dampness and heat and activates meridians. Modern pharmacological studies have confirmed that Atractylodes fumigatus has a significant inhibitory effect on a variety of bacteria and viruses, and its volatile oil has sedative and analgesic effects; Phellodendron has a broad-spectrum antibacterial effect, can significantly promote antibody production in mice, and also has a certain muscle relaxation effect. Treatment: Hormone
In the acute progressive stage, the patient is hyper-immune, and there is no co-infection or other contraindications, hormones can be applied, early IV, hydrocortisone 100-500 mg/day or dexamethasone 5-10 mg/day. Later, the hormone should be given orally at 0.75 mg-1.5 mg/dose 3 times a day or prednisone 5-20 mg/dose 3 times a day. If respiratory muscle paralysis has developed and assisted respiratory and immune function is low, and if respiratory tract infection has been combined, it is preferable to not use it. Intrathecal dexamethasone has been used to increase the concentration of the drug at the site of the nerve root lesion and may be more beneficial for lesion improvement. Plasma replacement therapy
It is considered to be effective, especially in young patients, and early application is good. Immunosuppression
It has been suggested that during progressive disease, short-term intravenous cyclophosphamide can abort its progression at 200 mg daily. Immunostimulants
For patients with low humoral immunity, passive immune boosters (e.g. gammaglobulin, intramuscular injection) may be given, and for those with low cellular immunity, transfer factors and immune ribonucleic acid may be beneficial. Interferon 5 mg, intramuscularly, once daily may also be given.
B-vitamins may be given in the non-acute phase
Galanthamine 5-10 mg, intramuscularly, once daily; Dibazol 10 mg, orally, three times daily.
Differential diagnosis The disease needs to 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. Treatment
1, comprehensive treatment and care to keep the respiratory tract unobstructed and prevent secondary infection is the key to treatment. If the swallowing and respiratory muscles are involved, coughing is weak and sputum is poorly evacuated; if necessary, tracheotomy and ventilator-assisted breathing should be performed; strengthen nursing care and turn more often to prevent
In case of facial palsy, protect the cornea to prevent ulceration. Because this disease can be combined with myocarditis, the heart should be closely observed and the amount of rehydration should not be too large.
2, hormone 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 applied intravenously, 400mg/kg.d for 5 days. It should be used as early as possible, but it is more expensive.
4.Plasma exchange therapy is a new treatment carried out in recent years, which 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, also can be applied at the same time vitamin B12. mikepro etc.
Chinese medicine treatment for the recovery period
1.Tui na: it can unblock the meridians and improve the circulation of Qi and blood in the limbs.
2, Chinese medicine: general recovery period belongs to Chinese medicine qi and yin two deficiency evidence, choose raw astragalus, raw yam, eucommia, white atractylodes, mulberry branch, scorpion, cow’s knee, Dan Shen, roasted licorice, party ginseng, dog’s spine, rehmannia, according to the specific condition, plus or minus to make soup or pill. 1 month a course of treatment. 1 course of treatment is not healed, can be considered under the guidance of the physician to take 1-2 courses of treatment.
Performance and typing
The clinical features are: 1~4 weeks ago, there are symptoms of gastrointestinal or respiratory tract infections and vaccination history, sudden onset of severe nerve root pain (more in the neck, shoulder, waist and lower limbs), acute progressive symmetrical limb weakness, subjective sensory impairment, weakening or loss of tendon reflexes.
The specific clinical manifestations are
1, motor disorders: limb bradykinesia is the main symptom of the disease, generally starting from the lower extremities gradually spread to the trunk muscles, both upper extremities and cranial nerves, hypotonia proximal often heavier than distal usually within a few days to 2 weeks to the peak of the development of critical conditions in 1-2 days rapidly aggravated to complete paralysis of the limbs respiratory muscle and swallowing muscle paralysis respiratory difficulties swallowing disorders life-threatening.
2, sensory disorders: generally lighter than motor disorders, but common limb sensory abnormalities such as tingling pain burning sensation can precede the paralysis or appear at the same time about 30% of patients have muscle pain sensation is indeed rare in the glove sock-shaped distribution of vibration and joint kinesthesia is usually preserved
3, reflex disorders: tendon reflexes of the extremities are mostly symmetrically weakened or disappeared abdominal wall torsades de pointes reflexes are mostly normal a few patients may have pathological reflex signs due to the involvement of the vertebral body bundle
4.Phytokinetic dysfunction: sweating and sweaty odor are often present in the initial or recovery period, probably as a result of sympathetic nerve stimulation. A few patients may have short-term urinary retention in the early stage due to temporary dysfunction of the phytokinetic nerves innervating the bladder or damage to the spinal nerves innervating the extensor muscles; constipation is often present in the stool; some patients may have unstable blood pressure, tachycardia, etc.
5, cranial nerve symptoms: half of the patients have cranial nerve damage with peripheral paralysis of the linguopharyngeal vagus nerve and one or both facial nerves, followed by peripheral paresis of the adductor nerve of the oculoglossus and occasionally the optic nerve papilla edema may be due to inflammatory changes in the optic nerve itself or cerebral edema, or may be related to the significant increase in cerebrospinal fluid protein blocking the arachnoid villi and affecting cerebrospinal fluid absorption.
There are variants of GBS and the number of reports is increasing. The knowledge of variant GBS can help in the diagnosis of GBS and prevent misdiagnosis.
1. Fisher syndrome: Fisher syndrome was first reported by Fisher in 1956 and has 5 major features.
(i) bilateral extraocular muscle paralysis.
(ii) bilateral symmetrical cerebellar ataxia.
(iii) loss of deep reflexes.
④ Separation of cerebrospinal fluid protein cells.
The first case of Fisher’s syndrome in China was reported by the author in 1979, and the number of reports in China has gradually increased since then.
2, ataxia type: Sun Shiji reported a case of ataxia type GBS, which mainly showed unstable walking, inability to move the hands, significant impairment of deep sensation, disappearance of tendon reflexes, nasal finger rotation, heel and knee shin test were not allowed RomDerg’s sign positive cerebrospinal fluid protein cell separation.