¨A síndrome de Guillain-Barré (SGB) é uma polirradiculoneuropatia inflamatória monofásica de caráter autoimune, caracterizada por rápida evolução ascendente de fraqueza de membros, quase sempre simétrica, hipo ou arreflexia e dissociação celuloproteica no líquido cefalorraquidiano (LCR). A doença pode chegar à máxima gravidade em até quatro semanas, com o desenvolvimento de insuficiência respiratória em aproximadamente 25% dos casos. Destes, a maioria tem completa recuperação. Entretanto, podem ocorrer sequelas graves e óbitos em até 20% e 5% dos casos, respectivamente. Após a eliminação da poliomielite, a SGB tornou-se a maior causa de paralisia flácida no mundo, representando um grave problema de Saúde Pública cuja incidência pode variar de 0,4 a 4 casos/100 mil habitantes em diferentes regiões do mundo. O envolvimento autonômico pode der proeminente. Frequentemente, a SGB é precedida por uma infecção. Há também relatos de SGB após vacinação ou trauma, como cirurgias, embora ambas as situações sejam consideradas raras e discutíveis. O agente mais comumente associado à infecção anterior é a bactéria Campylobacter jejuni, seguida de infecções por citomegalovírus, vírus Epstein-Barr (EBV), Mycoplasma pneumoniae, Haemophilus influenzae, vírus da influenza A, hepatite B e E, e vírus da imunodeficiência humana (HIV). Atualmente, também há registros de casos de SGB associados a infecções pelos vírus da dengue, chikungunya e Zika. O diagnóstico da SGB é feito de acordo com a apresentação clínica, resultados de eletroneuromiografia e características do líquido cefalorraquidiano. O líquido cefaloraquidiano de pacientes com SGB tem elevado conteúdo de proteínas, porém contagens celulares baixas (normais). Além do suporte clínico, o tratamento se baseia em imunoterapia por imunoglobulina intravenosa (IgIV) ou plasmaférese. A função pulmonar é monitorada cuidadosamente, com entubação em caso de insuficiência respiratória iminente. ¨
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by Dr Paulo Fernando Leite
Médico Cooperado Unimed BH – CRMMG: 7026
Belo Horizonte/Minas Gerais/Brasil
Email: pfleite1873@gmail.com