Guillain Barre Syndrome and Other Peripheral Neuropathies MCQs

The diagnosis is Guillain Barre syndrome . It is preceded by diarrhea (e.g. campylobacter) or chest infections (e.g. mycoplasma) in two thirds of cases. Autonomic dysfunction and hyporeflexia are associated. P rogressive symmetric ascending weakness is characteristic . Management: Plasma exchange (OR) IVIG (IV immunoglobulins) - 2 g/kg/day for 5 days. As effective as plasma exchange. Easier to administer and fewer side effects. No benefit in combining both treatments. Steroids and immunosuppressants have not been shown to be beneficial. Regular FVC (Forced vital capacity ) to monitor respiratory function and assess need for ventilation. ICU admission is recommended when FVC is less than 20 mL/kg and intubation is recommended in most cases when FVC is less than 15 mL/kg . Reference: Harrison's Principles of Internal Medicine, 21 ST Ed, Ch: 447, Pg: 3503

Ans. is 'b' i.e., Familial amyloidotic polyneuropathy Transthyretin (TTR) is normal serum protein that binds and transport thyroxine and retinol. TTR can cause following types of amyloidosis :? Mutant TTR : - Mutation in TTR can cause syndrome of familial amyloidotic polyneuropathy or familial amylodotic cardiomyopathy. Wild (non-mutant) TTR : - There is no mutation of TTR and wild type TTR forms fibrils which results in senile systemic amyloidosis (senile cardiac amyloidosis).

The basic abnormality in increased fasting glucose is high hepatic glucose output mainly due to reduced basal secretion of insulin or hepatic insulin resistance Raised post-prandial glucose values is due to decreased peripheral utilization (muscle and adipose tissue) First and second phase insulin secretion occurs in response to meals Reference: Harrison's Principles of Internal Medicine 21 st edition page 3096-3099

Though tricyclic antidepressants like amitriptyline are commonly employed for managing positive symptoms of diabetic neuropathy, they are not FDA approved Tapentadol is a central acting opioid analog with lesser evidence which is FDA approved Capsaicin patch has also been approved by FDA which works by interfering with the function of TRPV1 Venlafaxine, Oxcarbexapine, tricyclic antidepressants, gabapentin etc are others useful in the symptomatic treatment of neuropathy Reference: Harrison's Principles of Internal Medicine 21 st edition page 3124

GBS is associated with bulbar involvement occurs in 50%, with a risk of aspiration and respiratory insufficiency. In GBS, Symmetric involvement is typical. Asymmetrical involvement is present in only 9% of patients. CSF protein is elevated to more than twice the upper limit of normal, with normal glucose and no pleocytosis. Areflexia is commonly present. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 447, Pg: 3501

A sensory level is not a feature of GBS and would suggest cervical myelopathy. Guillian Barre Syndrome (GBS) is a post-infectious acute polyneuritis typified by elevated CSF protein with few cells and often normal glucose. There is a profound weakness associated with areflexia and peripheral sensory neuropathy. Ophthalmoplegia is associated in particular with the Miller-Fisher variant. Muscle wasting is typical with prolonged illness. Autonomic dysfunction can also occur. Reference: Harrison's Principles of Internal Medicine 21 st ed, Ch: 447, Pg: 3501

Steroids have no role in the treatment of GBS. Plasma exchange and I.V immunoglobulins are the mainstay treatment whereas ventilatory support may be needed during the course of GBS.

Answer is A and B (Cisplatin and Pyridoxine excess): Cisplatin and Pyridoxine are associated with predominantly sensory neuropathies.