GBS Case Report

CASE REPORT
GUILLAIN-BARR
B Y:
SYNDROME
Y O E L R AY S O R G I A S E M B I R I N G M E L I A L A
1
INTRODUCTION
2
INTRODUCTION
Guillain-Barre Syndrome is a rare condition

where the immune system attack the
peripheral nerves.
The attack towards peripheral nerves
cause inability to feel sensation or even
worse.
This syndrome could occur at any age.
Though Guillain-Barre Syndrome are rare,
but its still treatable.
3
OBJECTIVE
The objective of this case report is to

presenting a case of Guillain-Barre Syndrome
on a 5 years 9 months old girl.
4
CASE
5
CASE
NR, a 5 years 9 months old girl, came to the Pediatric

policlinic of Central Hospital of Haji Adam Malik on June
26th 2017, after referred from Rantau Prapat Hospital
with weakness of lower limb as her main problem.
This problem begin about 2 months ago, where
patients always fell when walking without any
stumble. In the beginning, patient still can stand after
fall, but few weeks later, patients unable to stand after
fall. History of tingling and numbness is found
about 3 to 4 months ago, but ignored by the patient or
her family. In the policlinic, the patient had no fever,
history of fever denied, cough and history of cough also
denied. Any history of diarrhea was denied. Both
defecation and urination are in the normal condition. 6
CASE
Her mother was 28th years old when she was

pregnant, and these was her first pregnancy and first
delivery, history of antenatal care was found regularly
every month to the midwife. History any disease
during pregnancy was denied. History of taking any
medication or herbal medicine was denied as well.
Patient was born spontaneously, the labor assisted by
a midwife, at term, crying immediately after birth and
history of bluish was not found. When birth, her
weight as 2800 gram with uncertain birth length.
History of vitamin K shot after birth was found.
Vaccination history was unclear.
CASE
Patient previously was treated in Rantau Prapat

Hospital for about 12 days, then reffered to Central
Hospital of Haji Adam Malik, Medan.
History of medication in Rantau Prapat Hospital is
unclear.
8
PHYSICAL EXAMINATION
Generalized state
Sensorium : Compos Mentis
Temperature : 36,8C
Body Weight (BW) : 15 kg
Body Height (BH) : 106 cm
BW/A: 75% | BH/A: 92% | BH/BW: 83%
Anemia (-), Cyanotic (-), Dyspnea (-), Edema (-), Icteric
(-)
9
Localized Status
Head:
Eye: Light reflex(+/+), isochoric pupil, anemic
inferior palpebral conjunctiva (-/-)
Ear, Nose, Mouth: any abnormality was not found.
Neck: Enlargement of lymph node (-)
Chest:
Fusiform symmetrical, retraction (-)
HR: 104 bpm, regular, murmur(-)
RR: 26 brpm, regular, rhonchi (-/-)
10
Abdomen:
Flexible, Peristaltic (+) Normal.
Enlargement of liver and spleen (-)
Extremity
Pulse: 104 bpm, regular, p/v strong, CRT <3
Lower limb weakness(+/+), KPR (-/-), Achilles
Reflex
(-/-)
11
LABORATORY EXAMINATION
Hb/Eri/Leu/Ht/T : 11,4/4,54/6.990/36/380.000
MCV/MCH/MCHC : 80/25,1/31,3
N/L/M/E/B : 71,9/24,7/3,4/0/0
Ca/Na/K/Cl : ,4/141/3,7/106
Ad-random glucose blood : 147mg/dL
BUN/Ur/Cr : 8/17/0,43
12
DIAGNOSIS
Differential Diagnosis
Guillain-Barr syndrome
Transverse myelitis
Polymyolitis
Diagnosis
Dd/ - Guillain-Barr syndrome
- Transverse myelitis
13
MANAGEMENT
Therapy
Inj. Methylprednisolone 375 mg/ 24 hours/IV
Inj. Ranitidine 15 mg/12 hours/IV
Investigation Plan
Vertebrae X-Ray
Vertebrae MRI
14
FOLLOW UP 27TH MAY 2017
S : Weakness of limb, fever(-), dyspnea(-)

O: Sensorium alert T:36,9 oC
Head :
Eyes : Pupil isochoric 2 mm, light reflex (+/+),
anemic inferior palpebral conjunctiva (-/-)
Thorax:
Fusiform Symmetrical, retraction (-)
HR 103 bpm, regular, murmur (-/-)
RR 26 brpm, regular, rhonchi (-/-)
Abdomen : Flexible, Peristaltic (+) Normal
Extremity : Limb weakness (+/+) Pulse 103 bpm, regular
A : Acute Transverse Myelitis
Guillain-Barre Syndrome
P : Inj. Metilprednisolone 375 mg/24 hours
Inj. Ranitidine 15 mg/12 hours
15
Result of Thoracal Vertebra PA/L X-Ray

Position of vertebrae thoracal is good
No lytic/blastic lesion seen, no fracture seen
No osteophyte formation seen
No narrowed of intervertebral disc seen
Soft tissue seen good
Conclusion : No abnormality of vert. thoracal seen
16

Head :
Thorax:
A : Acute Transverse Myelitis
P : Inj. Metilprednisolone 375 mg/24 hours
17

Head :
Thorax:
A: Acute Transverse Myelitis
P: Inj. Metilprednisolone 375 mg/24 hours
R/ Cervical MRI
18

O: Sensorium alert T:37,0oC
Head :
Thorax:
RR 20brpm, regular, rhonchi (-/-)
A: Guillain-Barre Syndrome
Acute Transverse Myelitis
19
Result of MRI Cervical :
Corpus vertebral cervical seen normal
Position of bones are normal
No prolapse of posterior disc seen
Spinal cord seen normal, no lesion seen
No intra/extra dermal lesion
Conclusion of MRI Cervical : There is no
abnormality on MRI Cervical
No sign of myelitis seen
20
FOLLOW UP 1ST JUNE 2017

Head :
Thorax:
21
FOLLOW UP 2ND JUNE 2017

Head :
Thorax:
22
DISCUSSION
23
DISCUSSION
Guillain-Barre Syndrome is one of acute or

subacute polyneuropathy which occurs after
infection, inoculation or surgical procedure or
probably without any precipitant.
Guillain-Barre Syndrome also known as Acute
Inflammatory Demyelinating
Polyradiculoneuropathy (AIDP).
Guillain-Barre Syndrome is characterized by an
immune-mediated attack on myelin sheath or
Schwann cells of sensory and motor nerves.
24
DISCUSSION
Some of clinical and epidemiological study shown

possibility of relationship between Guillain-Barre
Syndrome with previous Campylobacter jejuni infection.
Another study shown that two-third Guillain-Barre
Syndrome patients had infection in last 6 weeks before
the symptom occur, commonly respiratory tract infection.
Since 2013, several latest study show the association of
Zika virus infection with Guillain-Barre Syndrome
incidence.
In this case, any history of previous illness was denied.
But, there was a possibility of infection in previous time,
but forgotten by the parents or the patients.
25
DISCUSSION
Guillain-Barre Syndrome classified based on its symptoms and generally

divided into axonal and demyelinating form.
1) Sensory and motoric: Acute Inflammatory Demyelinating
Polyradiculoneuropathy (AIDP) or Acute Motor-Sensory Axonal
Neuropathy (AMSAN).
2) Motoric: Acute Motor Demyelinating Neuropathy (AMDN) or Acute Motor
Axonal Neuropathy (AMAN).
3) Pharyngeal-Cervical-Brachial: Acute arm weakness, swallow dysfunction
and weakness of facial muscles. 13
4) Acute Pandysautonomia: diarrhea, vomiting, abdominal pain, orthostatic
hypotension and urine retention, decreased sweating, salivation and
lacrimation.
5) Sensory: Acute sensory loss, sensory ataxia and areflexia without
motoric involvement.
In this case the type of Guillain-Barre Syndrome that the patient had is still
unclear due there are no EMG or NCS test.
26
DISCUSSION
Physical Exam of Theory Case

Head There could be cranial No involvement of
nerve involvement cranial nerve
Chest There could be attack There are no sign of
on respiratory involvement of both
muscles and/or heart respiratory or heart
muscles muscles
Extremity Loss of sensations, Lower limb weakness
numbness, limb (+/+), loss of
weakness sensation, previous
numbness
Physiology Reflex Decreased or absent Absent
27
DISCUSSION
Supportive Exam Theory Case

with
Blood screening To investigate There are no sign of
infection, but cant ongoing infection.
diagnose GBS
CSF Protein and Not performed
lymphocyte increased
Antigangliosides To determine the type Not performed
Antibody of GBS
Feces culture To review polymyolitis Not performed
or C. jejuni infection
MRI To see any sign of No sign of myelitis, all
myelitis kind of myelitis
diagnosis can be
eliminated.
EMG, NCS Most specific Not performed 28
diagnostic tool
DISCUSSION
Therapy for Guillain-Barr Syndrome is IVIG and

plasma exchange
In the case patient treated with
methylprednisolone and ranitidine.
29
DISCUSSION
Complication of Guillain-Barr Syndrome include

respiratory failure, arrhythmia and deep vein
thrombosis.
The prognosis is relatively good.
In the case, patient not show any sign of
complication.
30
CONCLUSION
31
CONCLUSION
A case has been reported, case of NR, a 5 years 9

months girl treated inpatient at Central Hospital of
Haji Adam Malik Medan, which based on
anamnesis, physical examination and additional
test, the patient diagnosed with Guillain-Barre
Syndrome and treated with 375 mg Injection
Methylprednisolone per 24 hours and 15 mg
Injection Ranitidine per 12 hours.
32
THANK YOU
33

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CASE REPORT

Guillain-Barre Syndrome is a rare condition

The objective of this case report is to

NR, a 5 years 9 months old girl, came to the Pediatric

Her mother was 28th years old when she was

Patient previously was treated in Rantau Prapat

S : Weakness of limb, fever(-), dyspnea(-)

Result of Thoracal Vertebra PA/L X-Ray

S : Weakness of limb, fever(-), dyspnea(-)

S : Weakness of limb, fever(-), dyspnea(-)

S : Weakness of limb, fever(-), dyspnea(-)

S : Weakness of limb, fever(-), dyspnea(-)

S : Weakness of limb, fever(-), dyspnea(-)

Guillain-Barre Syndrome is one of acute or

Some of clinical and epidemiological study shown

Guillain-Barre Syndrome classified based on its symptoms and generally

Physical Exam of Theory Case

Supportive Exam Theory Case

Therapy for Guillain-Barr Syndrome is IVIG and

Complication of Guillain-Barr Syndrome include

A case has been reported, case of NR, a 5 years 9

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