Thread by @KirtanPatolia

Guillain barre / GBS has an interesting differential diagnosis that has crucial management implications

Here is a thread based on what I have learned from my dear residents, attendings & journals

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#1 GBS

- Infxs (C. jejuni, Mycoplasma, EBV, CMV, Zika,Influenza, HIV)
- Ascending weakness
- Cranial nerve involvement (CN 7)
- Usually no bowel/bladder disturbances
- Cyto-albuminologic dissociation and areflexia (may not manifest very early on)
- Rx - IVIG & Plasmapheresis

#2 GBS Variants and antibodies:

- AIDP
- Facial diplegia and paresthesia
- AMAN & AMSAN (GM1, GD1a)
- Phayngeal-Cervical-Brachial weakness (GT1a/GQ1b)
- Miller Fisher (GQ1b) (Areflexia + Ataxia + Opthalmoplegia)
- Bickerstaff encepahlitis (GQ1b)
- Pure Autonomic variant

#3 Periodic Paralysis/PP (Ca, Na, K channelopathies)

- Hypokalemic PP
- Hyperkalemic PP
- Normokalemic PP
- Thyrotoxic PP
- Andersen-Tawil (PP + LQTS/arrhythmias + dysmorphic features , KCNJ2)

May be complicated by myopathy in severe/chronic forms.

#4 Transverse myelitis/ Myelopathy

- Infections vs Autoimmune vs Neoplastic vs Vascular insults
- Structural (Epidural abscess/hematoma/disc herniation/osteomyelitis/meningeal infiltration)
- Bowel/Bladder disturbances +/- Sensory level + hyperreflexia

#5 Metabolic (Acute Intermittent Porphyria, Lead, Tyrosinemia-I)

All of them perturb heme synthesis- accumulation of intermediates-symptoms

- Recurrent abdominal pain + Altered mental status/psychosis + seizures + hyponatremia + neuropathy
- Rx - IV hemin, Glucose, chelation

#6 Viruses & other Infections

- West Nile Virus, Enterovirus, Polio, Coxsackie, Echovirus (Anterior horn cells involvement)
- CMV polyradiculitis
- Rabies (Paralytic variant)
- Lyme polyradiculitis
- Diptheria

#7 NMJ disorders

- Myasthenia gravis (descending with prominent ocular involvement + preserved reflexes +/- thymoma)
- Botulism (Descending with loss of pupillary reflex)
- Lamber Eaton myasthenic syndrome (Ascending + loss of reflexes + Autonomic symptoms + Paraneoplastic)

#8 Poisoning ( Heavy metals & Fishes)

- Arsenic
- Thallium
- Lead
- Organophosphates
- Paralytic shellfish poisoning
- Amnesic shellfish poisoning (Domoic acid poisoning)
- Ciguatera toxin
- Tetrodotoxin
- Batrachotoxin

#9 Miscellaneous

- Tick borne paralysis
- Conversion disorder
- Critical illness myopathy/neuropathy
- Severe hypophosphatemia

That's the end

Any suggestions appreciated

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