Gulliain Barre Syndrome: A case report

Manimekalai¹, V. Gayathri Devi², S. J. Sonya Mercy Anbu³, Ruby Ravichandran⁴

¹Staff Nurse, Maa Kauvery, Trichy, Tamil Nadu

²Nursing Supervisor, Maa Kauvery, Trichy, Tamil Nadu

³Nurse Educator, Maa Kauvery, Trichy, Tamil Nadu

⁴Senior Deputy Nursing Superintend, Maa Kauvery, Trichy, Tamil Nadu

Introduction

Gulliain Barre Syndrome is a condition in which the body’s immune system attacks the nerves. It can cause weakness, numbness, or paralysis. Weakness and tingling in the hands and foot are usually the first symptoms. These sensations can quickly spread and may lead to paralysis.

Definition

Guillian Barre Syndrome is an auto immune disorder that affects the peripheral nervous system. Specifically, they affect the myelin sheaths surrounding the axons of nerve cells. in some cases they affect the axons themselves.

Case presentation

A 1 yr aged male child was admitted with the complaints of sleep disturbances followed by cough 1week, decreased activity for 5 days, lethargy 2 days, drowsiness 1 day, fast breathing 2 days decreased oral intake 2 days.

Clinical findings

Child afebrile
Pallor present
Bilateral brachial and radial pulse present.
Lower limb pulse volume good
Lower limb weakness present
Respiratory muscle weakness present.

Past medical & surgical history

There is no significant past medical history.

Birth history

Term LSCS birth weight 2.6kg, cried after birth, no history of NICU stay.

Family history

There is no relevant family history.

Developmental history

Attained developmental milestones at appropriate age.

Immunization status

Immunized till date.

Investigations

Investigations	16.2.2025	19.2.2025	28.2.2025
Haemoglobin	9.1	7.2	8.5
PCV	31.5	23.7	27.5
WBC	24630	8840	11850
platelet	526000	464000	434000
sodium	140	131	134
Magnesium	1.87
Bicarbonate	17.5	23.3	24.6
Urea	20
Creatinine	0.25
Calcium	9.34
Phosphorous	4.77
Chloride	107	102	101
CRP	25.2

MRI Brain with Whole Spine

Normal study of brain with focal lesion in subgaleal space of right parieto occipital region.

Nerve Conduction Study

Nerve conduction study revealed motor axonal neuropathy, AMAN variant of GBS.

Management

A 1 year 9 month old child premorbidly normal. Now brought with history of cough, coryza, decreased activity, fast breathing and decreased oral intake.
He was initially treated in nearby hospital admitted and diagnosed as viral pneumonia /acute respiratory syndrome/ respiratory failure/ fluid refractory shock.
He was started on HFNC and IV antibiotics, antiviral Ionotropic support.
On evaluation blood investigation revealed mild anaemia with leucocytosis with negative CRP.
On presenting to ER child had poor respiratory effort with GCS of E2V1M3, hence child was intubated and connected to mechanical ventilation support.
Day 2 arterial blood gas analysis showed resolving type 2 respiratory failure. Repeated investigation hypokalemia which was corrected.
On day 2 sedation window was given while assessing, child had partial eye opening with ptosis, symmetrical weakness with hypotonic and areflexia in all 4 limbs, absent abdominal and cremasteric reflex.
Possibility of Landry GBS as considered. EGRIS (Erasmus GBS respiratory insufficiency score) score of 6 with MRC grade -4/60.
Nerve conduction study revealed motor axonal neuropathy AMAN variant of GBS. IV immunoglobulin was initiated 2g/kg. Paediatric neurologist opinion was sought out and was advised to continue IV IG therapy.
During PICU stay child developed intermittent bradycardia, due to autonomic instability which was treated with inj. Atropine
On day 13 of admission, child developed high grade fever spikes, possibility of atypical infection was considered. Oral Antibiotic was started (syp. Augmentin).
Child has no significant neurological improvement and had persistent acute flaccid paralysis. Second dose IV IG given.
Limb and chest physiotherapy given. On day 16 of PICU stay, in view of need for prolonged mechanical ventilation and hospital stay, child underwent elective tracheotomy.
During a course of PICU stay child was gradually improved GCS -E4VTM5 with MRC grade of 10/60, remained hemodynamically stable.
The nature of the disease and its prognosis, tracheostomy care and suctioning, physiotherapy were clearly explained to the parents. Child shifted to HDU.
During HDU stay, child was on BIPAP, support. Swallowing pathologist review obtained and child was started on liquid and eventually to semi solid diet.
Child was awake, febrile, no respiratory distress, hemodynamically stable and shifted HAMSA rehabilitation centre for further care.

Treatment in hospital

S.No	DRUG NAME/DOSE	ROUTE	FREQUENCY
1	Inj. Ceftriaxone 500mg	IV	BD
2	Inj. Vancomycin 200mg	IV	TDS
3	Syp. Azithromycin 5ml	P/O	OD
4	Syp. Fluvir2.5ml	P/O	BD
5	Syp. Zincovit 2.5ml	P/O	BD
6	Syp.Hemefer 4ML	P/O	TDS

Nursing management

Tepid sponging given to reduce temperature
Observed continuously for adequacy of respiratory effort.
Continuous ECG monitoring done
Supportive nursing care measures such as periodical repositioning to prevent pressure injury.
Frequent suctioning initiated to clear the secretions and maintained patent airway to improve oxygenation
Regular chest physiotherapy and limb exercises provided to aid the clearance of secretions and ease limb flexibility.
Provided periodical ambulation out of intensive care unit whenever possible to divert and support child’s emotional status.
Provided play therapy to convert and encourage child to recover early.

Health education

Advised the parents to give adequate rest.
To give medications exactly as prescribed.
To monitored breathing difficulty, muscle weakness.
To give healthy diet (High protein &High calorie diet).
To follow chest and limb physiotherapy regularly
To follow up appointments with the paediatric neurologist.

Advised the parents to report immediately if baby has excessive dullness, continuous cough, cold, high grade fever, fast breathing, difficulty in breathing, excessive diarrhoea, vomiting, reduced urine output.

Advice on discharge

S.No	Drug Name	Generic name / Strength	Frequency (M)	Frequency (A)	Frequency (N)	Route of admin	Relationship with meal	Days
1	SYP. ZINCOVIT	MULTIVITAMIN	2.5ML	0	2.5ML	ORAL	AFTER FOOD	TO CONTINUE
2	SYP. HEMFER	IRON SUPPLEMENTS	4ML	4ML	4ML	ORAL	AFTER FOOD	TO CONTINUE
3	NEB. 3 % NACL	3% sodium chloride		3ML (SOS)		Per nasal		—

Conclusion

This case study highlights the importance of early recognition, prompt diagnosis, and comprehensive management of Guillain-Barré Syndrome. Timely initiation of treatment such as intravenous immunoglobulin (IVIG), along with supportive nursing care and physiotherapy, plays a vital role in improving patient outcomes and preventing complications. A multidisciplinary approach, including close monitoring of respiratory function and rehabilitation, is essential for recovery.

This case emphasizes the need for healthcare professionals to maintain a high index of suspicion for GBS in patients presenting with progressive weakness, ensuring early intervention and better prognosis.

Gulliain Barre Syndrome: A case report

Gulliain Barre Syndrome: A case report

Manimekalai1, V. Gayathri Devi2, S. J. Sonya Mercy Anbu3, Ruby Ravichandran4

Nightingale Journals

Manimekalai¹, V. Gayathri Devi², S. J. Sonya Mercy Anbu³, Ruby Ravichandran⁴