Neurological Disorders Q 107

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A female client is admitted to the hospital with a diagnosis of Guillain-Barre syndrome. The nurse inquires during the nursing admission interview if the client has a history of:

  

     A. Seizures or trauma to the brain.

     B. Meningitis during the last five (5 years).

     C. Back injury or trauma to the spinal cord.

     D. Respiratory or gastrointestinal infection during the previous month.

    

    

Correct Answer: D. Respiratory or gastrointestinal infection during the previous month.

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Guillain-Barré syndrome is a clinical syndrome of unknown origin that involves cranial and peripheral nerves. Many clients report a history of respiratory or gastrointestinal infection in the 1 to 4 weeks before the onset of neurological deficits. Occasionally, the syndrome can be triggered by vaccination or surgery.

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Option A: Many infections have been linked with GBS. The most common are gastrointestinal or respiratory illnesses. Up to 70% of patients have reported an antecedent illness in the 1 to 6 weeks before the presentation of GBS. During the Zika virus outbreak, many GBS cases were described. Case reports detail many other possible etiologies linked to GBS including medications and surgeries.

Option B: The Guillain-Barre syndrome (GBS) and its variants are considered post-infectious, immune-mediated neuropathies. Evidence from animal models suggests a key role of molecular mimicry. In Campylobacter jejuni gastrointestinal infections, a lipooligosaccharide present in the outer membrane of the bacteria is similar to gangliosides that are components of the peripheral nerves. Therefore, an immune response triggered to fight infection can lead to a cross-reaction on host nerves.

Option C: In 1976, flu vaccination against the influenza A/H1N1 antigen led to a well-documented, increased incidence of cases of GBS; however, further surveillance data of flu vaccinations in subsequent years have described only one additional case of GBS for every 1 million vaccines. Subsequent studies estimate that developing GBS after a flu infection is up to 7 times more likely than developing GBS after a vaccination.

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