Guillain-Barré
Syndrome
Disusun oleh :
Celine (406162058)
NEUROLOGY Penguji :
ROYAL TARUMA HOSPITAL dr. Martin Firman Suryo, Sp.S, FIPM
FACULTY OF MEDICINE
TARUMANAGARA UNIVERSITY
KASUS
IDENTITAS
Nama : Tn. TAP Jenis Kelamin : Laki laki
TTL: Jakarta, 10– 06 – 1971
Usia : 47 tahun Suku Bangsa : Jakarta
Pendidikan terakhir : SMA Agama : Kristen
Alamat : Jl. Sumbawa Dalam Gang Tanggal Masuk RS : 20-12-2018
Jawa Blok F4 No. 9 Menceng
DAHULU KELUARGA
• Riwayat batuk, pilek, demam, diare, • Tidak ada anggota keluarga yang
mual-muntah disangkal mengalami hal serupa
• Riwayat stroke disangkal
• Riwayat Hipertensi, Diabetes Mellitus,
Hiperkolesterolemia (-)
• Riwayat alergi (-)
PEMERIKSAAN FISIK
• Kesadaran (GCS) : E4 V5 M6 = 15 Compos Mentis
• KU : Tampak sakit sedang
• TD : 110/70 mmHg
• Nadi : 86-90 x/min
• Suhu : 36.8 – 37.0 ⁰C
• Pernapasan : 18 x / menit dengan ventilator (terpasang ETT)
• BB : 69 kg
• C/P : BJ I & II normal, murmur(-), gallop (-), vesikuler (+/+), Rh (+/+)
Wh (-/-)
PEMERIKSAAN FISIK
• Kepala: normocephali, tidak teraba massa, rambut berwarna hitam, terdistribusi merata,
tidak mudah dicabut, kulit kepala tidak ada kelainan
• Mata: bentuk simetris, pupil bulat, isokor 3mm/3mm, refleks cahaya langsung (+/+), refleks
cahaya tak langsung (+/+), konjungtiva anemis (-/-), sklera ikterik (-/-), mata cekung (-)
• Hidung: deviasi (-), sekret (-/-), napas cuping hidung (-/-), mimisan (-)
• Telinga: bentuk normal, nyeri tekan (-/-), sekret (-/-), refleks cone of light (+/+)
• Mulut: sianosis (-), mukosa oral kering (-), faring hiperemis (-), tonsil T1/T1, hiperemis (-),
tremor lidah (-), lidah kotor (-), gusi berdarah (-)
• Leher: trakea di tengah, pembesaran KGB (-)
PEMERIKSAAN FISIK
•Thorax
• Paru-paru
• Inspeksi : Bentuk simetris dalam keadaan statis dan dinamis,
• Palpasi : Tidak teraba massa, krepitasi (-), nyeri (-)
• Perkusi : Sonor pada kedua lapang paru
• Auskultasi : Vesikuler (+/+), rh (-/-), wh (-/-)
• Jantung
• Inspeksi : pulsasi iktus kordis tidak tampak
• Palpasi : Pulsasi iktus kordis teraba di ICS IV MCLS.
• Perkusi : batas jantung dalam batas normal
• Auskultasi : S1 dan S2 normal, murmur (-), gallop (-)
PEMERIKSAAN FISIK
Abdomen
• Inspeksi : tampak datar, jejas (-), massa (-)
• Auskultasi : BU (+) 6-9 x/ menit, bruit (-)
• Palpasi : supel, massa (-), nyeri tekan (-), hepatomegali (-), splenomegali (-)
• Perkusi : timpani, shifting dullness (-), ketok CVA -/-
• Tulang Belakang : dalam batas normal, kifosis (-), lordosis (-), skoliosis (-)
• Ekstremitas : akral hangat, CRT 2 detik, edema (-/-)
• Kulit : dalam batas normal, sianosis (-), petekie (-)
• KGB : Pembesaran KGB (+) coli sinistra
PEMERIKSAAN NEUROLOGIS
• Kaku kuduk (-)
• Rangsang Meningeal :
• Brudzinski I-IV (-)
• Laseque (-)
• Kernig (-)
PEMERIKSAAN NEUROLOGIS
• Nervus Craniales :
• N.I Olfactorius tidak dilakukan
• N. II Opticus Lapang pandang ()
• N. III, IV, VI Occulomotorius, Trochlearis, Abducens
• Ptosis (-/+), pupil isokor, reflex cahaya langsung (+/+), reflex cahaya tidak langsung (+/+), gerak
bola mata (),
PEMERIKSAAN NEUROLOGIS
• Nervus Craniales :
• N.V Trigeminus motorik (tidak dapat dilakukan), sensorik ()
• N. VII Fasialis motorik (), sensorik (tidak dilakukan)
• N. VIII Vestibulocochlearis Pendengaran tidak terganggu
• N. IX Glossofaringeus tidak dapat dilakukan (terpasang ETT)
• N. X Vagus tidak dapat dilakukan (terpasang ETT)
• N. XI Accessorius mengangkat bahu, memalingkan kepala dapat sama kuat
• N. XII Hypoglossus tidak dapat dilakukan (terpasang ETT)
PEMERIKSAAN NEUROLOGIS
• Reflek Fisiologis : biceps (+/+), triceps (+/+), patella (+/+), achilles (+/+)
• Reflek patologis : Babinski (-/-), Chaddock (-/-), Gordon (-/-), Schaeffer (-/-), Hoffman-
Tromner (-/-), Oppenheim (-/-), Klonus paha (-/-), Klonus kaki (-/-), Rossolimo (-/-), Mendel-
Bechterew (-/-)
Campylobacter jejuni,
cytomegalovirus, Epstein-
Barr virus, Mycoplasma
pneumoniae, Haemophilus
influenza, and Varicella-
zoster virus
Molecular mimicry
Clinical Spectrum
• There are several places in the peripheral nervous system where the inflammatory response of
GBS can begin, depending on the subtype that develops and the infectious pathogen that is
involved
Diagnosis
• Clinical features :
• Ascending weakness and symmetrical in nature. Severity may range from mild weakness to complete
tetraplegia with ventilatory failure
• Cranial nerve involvement (Facial droop (may mimic Bell palsy), diplopias, dysarthria, dysphagia,
ophthalmoplegia, pupillary disturbances)
• Sensory changes (paresthesias, numbness)
• Pain (often described as aching or throbbing)
• Autonomic changes (tachycardia, bradycardia, facial flushing, paroxysmal hypertension, orthostatic
hypotension, anhidrosis and/or diaphoresis)
• Urinary retention due to urinary sphincter disturbances may be noted. Constipation due to bowel paresis
and gastric dysmotility may be present
• Respiratory Involvement (dyspnea on exertion, shortness of breath, difficulty swallowing, slurred speech)
• Antecedent illness (1-3 weeks prior to the onset of weakness. Upper respiratory and gastrointestinal
illnesses are the most commonly reported conditions)
Diagnosis
• Workup :
• Basic laboratory studies, such as complete blood counts (CBCs) and metabolic panels
• Lumbar puncture for cerebrospinal fluid (CSF) studies is recommended
• characteristic findings on CSF analysis include albuminocytologic dissociation, which is an
elevation in CSF protein (>0.55 g/L) without an elevation in white blood cells. The increase in CSF
protein is thought to reflect the widespread inflammation of the nerve roots
• Electromyography (EMG) and nerve conduction studies (NCS)
• Imaging studies, such as magnetic resonance imaging (MRI) and computed tomography (CT)
scanning of the spine, may be more helpful in excluding other diagnoses
Clinical Course
• The clinical course of GBS is divided into three phases:
1. The initial phase begins when the first definitive symptom develops; it ends one to three
weeks later, when no further deterioration is noted
2. The plateau phase lasts several days to two weeks
3. The recovery phase is believed to coincide with remyelination and axonal process
regrowth. This phase extends over four to six months; patients with severe disease may take
up to two years to recover, and recovery may not be complete
Complications
• Mechanical ventilatory failure
• Aspiration pneumonia
• Sepsis
• Joint contractures
• Deep vein thrombosis
• Unexplained autonomic nervous system involvement may cause sinus tachycardia or
bradycardia, hypertension, orthostatic hypotension, and loss of bladder and bowel sphincter
control
Treatment
• Plasmapheresis or Plasma exchange
• Intravenous Immunoglobulins (IVIg)
• Conservative and supportive
• Another treatment, corticosteroids, or cortisone, was not found to be beneficial and is not
recommended in the treatment of Guillain-Barré patients