tailieunhanh - ESSENTIAL NEUROLOGY - PART 7

Nguyên nhân của hội chứng Guillain-Barré chết có thể gây tử vong, nhưng hầu hết trong những nguyên nhân có thể tránh được: • nguyện vọng viêm phổi • huyết khối tĩnh mạch sâu và thuyên tắc phổi • loạn nhịp tim Vì vậy, theo dõi chức năng hành tủy, dung tích sống và trái tim, và anticoagulate | PERIPHERAL NEUROMUSCULAR DISORDERS 163 Causes of death Guillain-Barré syndrome can be fatal but most of the causes are avoidable aspiration pneumonia DVT and pulmonary embolism cardiac arrhythmia So monitor bulbar function vital capacity and the heart and anticoagulate Guillain-Barré syndrome Guillain-Barré syndrome is rather different from the other forms of peripheral neuropathy. This is because of its rapid evolution over several days because it can produce a lifethreatening degree of weakness and because the underlying pathology clearly affects the nerve roots as well as the peripheral nerves. The syndrome commonly occurs a week or two after an infection such as Campylobacter enteritis which is thought to trigger an autoimmune response. The patient notices limb weakness and sensory symptoms which worsen day by day for 1-2 weeks occasionally the progression may continue for as long as 4 weeks . Often the illness stops advancing after a few days and does not produce a disability that is too major. Not uncommonly however it progresses to cause very serious paralysis in the limbs trunk and chest muscles and in the muscles supplied by the cranial nerves. Involvement of the autonomic nerves may cause erratic rises and falls in heart rate and blood pressure and profound constipation. Patients with Guillain-Barré syndrome need to be hospitalized until it is certain that deterioration has come to an end because chest and bulbar muscle weakness may make ventilation and nasogastric tube nutrition essential. Daily or twice daily estimations of the patient s vital capacity during the early phase of the disease can be a very valuable way of assessing the likelihood of the need for ventilatory support. Prompt administration of intravenous immunoglobulin or plasma exchange can prevent deterioration and the need for ventilation in many cases. Steroids have not been shown to be of proven benefit. Patients with Guillain-Barré syndrome become very alarmed by the progressive loss .