Guillain-Barre Syndrome

My patient he is 53 years old. He is paraplegic which means paralysis of the lower half of the body and both legs. He is bowel and urine incontinent.

His other diagnosis are

Guillain-Barre syndrome

Type 2 diabetes

Hypertension

MRSA positive test that's why he was on isolation.

On March 5th, he was admitted to hospital because of abductor paralysis and on March 11 they did right laser arytenoidectomy cordotomy.

He also had a tracheostomy and supra pubic catheter.

The vocal cords are basically two folds of tissue composed of muscle in the front and cartilage in the back. They are positioned side by side at the top of the airway in the voice box (larynx). The vocal cords open to enable us to breathe easily, and close to allow us to speak or sing. They also close when we eat or drink, to prevent solids or liquids from getting into our airway.

1. Abductor paralysis also know as vocal cord paralysis in which the loss of nerve and motor supply to the vocal cords resulting in fixation and abnormal position of one or both cords and these cords lie in the midline or paramedian position.

If the vocal cords are immobilized in the closed position, the patient has trouble breathing, produce a faily clear voice or cry and a tracheotomy is performed. In this procedure, an incision is made in the front of the neck below the vocal cords and a breathing tube is inserted through a surgically created hole into the windpipe (trachea). The patient then breathes through the tube, bypassing the paralyzed vocal cords.

And they did arytenoidectomy.

Arytenoidectomy is a procedure in which one arytenoid cartilage is removed and glottis is opened posteriorly to widen the airway.

Vocal cord paralysis is the result of either disease or injury to the superior or recurrent laryngeal nerve, which is the branch of the vagus nerve that provides the entire motor supply to the larynx.

In my patient's case abductor paralysis is associated with Guillain-Barré syndrome

2. Guillain-Barre syndrome also know as Infectious polyneuritis

Guillain-Barré syndrome is a nerve disorder. It is an acute and rapidly progressive inflammation of nerves that causes loss of sensation, tingling, diminished reflexes,

muscle weakness and paralysis

This syndrome causes the destruction, removal, or loss of the myelin sheath of a nerve. Myelin is the substance of the cell membrane that coils to form the myelin sheath. The myelin sheath serves as an electrical insulator to nerve fibers. Such damage is called demyelination. Demyelination slows nerve signaling. Damage to other parts of the nerve can cause the nerve to stop working.

It is also known as a polyneuropathy, which is a disease that involves several nerves.

Guillain-Barre syndrome is an autoimmune disorder. It occurs when the body's defense (immune) system mistakenly attacks part of the nervous system. This leads to nerve inflammation.

Causes The exact cause of Guillain-Barre syndrome is unknown. It often follows a minor infection, usually a respiratory (lung) infection or gastrointestinal (gut) infection.

It may occur along with viral infections, after a bacterial infection, certain vaccinations (such as rabies and swine flu), and surgery.

GBS is a life event with a potentially long-lasting influence on patients' physical and psychosocial well-being.

Assessments

Because of above said syndrome he has-

* Loss of muscle strength to lower extremities. He was unable to flex his knee and feet.

* Because of paralysis he has foot drop which means inability to raise the front part of the foot

* He complains of extreme pain with slight leg movement. He always keeps his legs in slight flex position. -

* He has a zero strength for hand grasp because of absence of flexion in fingers and hand, but he can flex his elbow.

Lab. values

Blood creatinine level

The blood creatinine level shows how well your kidneys are working. A high creatinine level may mean your kidneys are not working properly. The amount of creatinine in the blood depends partly