Acute Flaccid Paralysis

Question 1

Diseases and their features in weakness symmetrical or asymmetrical ,sphincter dysfunction,plantar reflexes and sensory signs

Answer 1

AIDP (GBS)
poliomyelitis
Spinal cord compression shock stage

Question 2

AIDP N CIDP difference?

Answer 2

AIDP < 4 weeks
CIDP > 4 weeks

Question 3

General features of GBS?

Answer 3

4
-most commonly post infection,2/3 of pt have symptoms of an infection 3 w. Efore the illness
-pathogenesis-
Following infection the antigen presenting cells present microbial antigen to T and B lymphocytes
The ab produced by B cells cross react with myelin gangliosides on motor neurons which results in segmental demyelination of nerve root and peripheral nerves, later myelin regeneration and repair occurs.
-commonest infection is campylobacter jejuni
-other - CMV,EBV,mycoplasma pneumonia,haemophilusinfluensa

Question 4

Clinical features of GBS?

Answer 4

5
1st symptoms- pain,numbness and parasthesia
Rapidly progressive (days) ascending paralysis with LL,UL,cranial nerves (typically bl LMN facial nerve palsy)
Global areflexia
No sensory signs
Doesn’t progress beyond 4 weeks (in real life not >2 w),reach max weekness within 2 weeks

Question 5

Complications?

Answer 5

Respiratory muscle paralysis
Autonomic dysfunction (PR & BP)

Question 6

Dx of GBS?

Answer 6

3
1.Clinical picture of ascemding flaccid paralysis
2.Nerve conduction studies
3.CSF EX at 10-14 days
-to exclude other causes such as HIV
-in atypical presentation
ALBUMINO-CYTOLOGICAL DISSOCIATION (high protein or albumin content and no ^ in cells/wbc)

Question 7

Mx og GBS?

Answer 7

1.monitor progression 3
-muscle power in limb
-respiratory muscle paralysis
-autonomic dysfunction

Respi muscle paralysis
-vital capacity (N-75ml/kg,ICU <20 ml/kg,ventilate <15 ml/kg
-Single breath count (N>25, admit in ICU if progressively reducing)
-initially check evry 2-4 hrs ,in stable phase 6-12 hrs
-PEFR,SaO2 (pulse oxymetry), ABG, RR -not sensitive,too late

Autonomic dysfunction
-PRor HR
-BP
-initial every 2-4 hrs
-if severe autonomic fluctuations admit to ICU

2.prevent n manage potentially fatal complications
3.GENERAL CARE 6
-artificial tears (corneal ulcers)
-stockings,heparin (stockings heparin)
-Check for swallowing and NG if indicated (prevent aspiration)
-skin care,prevent decubitus ulcers
-bladder and bowel care
-recognize and treat pain

4.SPECIFIC THERAPY
-IVIg
-plasma exchange
-no place for steroids
Reduce time to recover ,need for ventilation and reduce dissapbility
Benifucail within 2 w of onset
Efficiency IVIg= PE

5.rehabillitation
Start physiotherapy early diring caise of disease
Strat rehabilitation as soon as improvements start