Zeyaur Rahman Azad, (2011) Study of Autonomic dysfunction in patients with Guillain- Barré Syndrome (GBS). Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: Guillain Barre syndrome is an immune mediated inflammatory disease of the PNS characterized by rapidly evolving symmetrical limb weakness, loss of tendon reflexes and absent or mild sensory signs .Autonomic neuropathy is an important and common complication of Guillain-Barré syndrome (GBS) and may be life threatening at time.The available studies showed variable incidence of autonomic dysfunction in GBS and its relation with the severity of motor paralysis and sensory disturbances. OBJECTIVES: To study autonomic nervous system involvement in a group of patients’ with Guillain- Barré syndrome (GBS) to assess its clinical significance and relation with clinical severity of GBS and its subtypes. METHODOLOGY: Continuous recording of HR and BP and longitudinally performed autonomic function tests’, including HR response to deep breathing and standing, valsalva ratio, postural change of systolic BP and cold immersion test were done once daily for the first 3 days of admission followed by once every week. The recordings’ were continued till the 4th week of illness or improvement by 1 functional grade (Hughe’s Grading), whichever was earlier. RESULTS: 8 patients (7AIDP/IAMAN) were included for longitudinally performed autonomic function tests’ (ATs). Autonomic dysfunction were detected in 7/8 patients (87.5%) including one AMAN. Two patients (25%) had dysautonomia of severe grade with NTAS >16. Symptoms of dysautonomia were reported in 6/8 patients (75%) of which it was started 1-5 days before the onset of motor weakness in 3 patients. The most frequent manifestation of dysautonomia in our patients was sinus tachycardia (87.5%) followed by Hypertension, labile HR and labile BP(75 % each).Episodes of hypotension was reported in 50% patients where as bradycardia in 37.5% patients. HR response to deep breathing (I-E differences) was abnormal in 3/ 6 patients (50%), where as HR response to active standing (30:15 ratio) 1/2 patients who was able to perform the test. Valsalva ratio was abnormal in one of 2 patients (50%). 62.5% of patient fails to rise of diastolic BP significantly in Cold immersion test where as 50 % patients who was able to stand unsupported was showing significant fall of systolic BP on standing at or before 3 min. SSR was absent in 62.5% patients (4 AIDP /1AMAN) in both upper and lower limbs. All patients in whom SSR was absent , had evidence of dysautonomia. CONCLUSION: The present study demonstrated high incidence of autonomic dysfunction in patient with GBS (87.5%). Fifty percent patients had evidence of both sympathetic and parasympathetic dysfunction, 25% patients predominantly sympathetic dysfunction where as 12.5% patients had predominantly parasympathetic dysfunction. The presence and severity of dysautonomia (NTAS) was not related to motor disability, sensory disturbances and use of mechanical ventilation but was correlated with older age (>45 yrs) of onset of illness.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Autonomic dysfunction, Guillain-Barré Syndrome (GBS). |
| Subjects: | MEDICAL > Neurology |
| Depositing User: | Subramani R |
| Date Deposited: | 14 Feb 2020 02:48 |
| Last Modified: | 14 Feb 2020 02:48 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11924 |
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