L5: Acute Flaccid Paralysis Flashcards
Introduction to motor unit
Def of
- Neuronopathy
- Neuropathy
- Myopathy
Def of Acute Flaccid Paralysis
Etiology of Acute Flaccid Paralysis
Etiology of Acute Flaccid Paralysis
- Spinal Cord
- Acute transverse myelitis
- Trauma
Etiology of Acute Flaccid Paralysis
- AHCs
- Poliovirus & polio vaccination
- Other neurotropic viruses e.g. CMV, EBV, HSV
Etiology of Acute Flaccid Paralysis
- Peripheral Nerves
- Guillain Barrรฉ syndrome
- Critical illness neuropathy
- Toxic neuropathy (arsenic, lead)
- Diphtheritic neuropathy
Etiology of Acute Flaccid Paralysis
- NMJ
- Myasthenia gravis
- Botulism
- Organophosphate poisoning
- Snakebite
Etiology of Acute Flaccid Paralysis
- Muscles
- Inflammatory myopathies
- Critical illness myopathy
Etiology of Acute Flaccid Paralysis
- Muscle Membrane
- Familial periodic paralysis
- 2ry hypokalemic paralysis
CP of Acute Flaccid Paralysis
CP of Acute Flaccid Paralysis
- Weakness appears first in โฆ..
Lower Limb
CP of Acute Flaccid Paralysis
- Initial Complaint
Abnormal gait with proximal or distal leg weakness
CP of Acute Flaccid Paralysis
- With Proximal Weakness
CP of Acute Flaccid Paralysis
- With Distal Weakness
Physical Examination in Acute Flaccid Paralysis
Dx of Acute Flaccid Paralysis
INVx in Acute Flaccid Paralysis
INVx in Acute Flaccid Paralysis
- Spinal Cord Lesions
INVx in Acute Flaccid Paralysis
- Peripheral Nerve Lesions
INVx in Acute Flaccid Paralysis
- NMJ Lesions
Repetitive nerve stimulation (RNS)
INVx in Acute Flaccid Paralysis
- Muscle Lesions
Manamgment of Acute Flaccid Paralysis
Manamgment of Acute Flaccid Paralysis
- ABC
- Ensure airway protected and adequate ventilation
- Check BP & HR
Manamgment of Acute Flaccid Paralysis
- Specific TTT
Introduction to Guillian Barrรฉ Syndrome
Epidemeology of Guillian Barrรฉ Syndrome
Etiology of Guillian Barrรฉ Syndrome
Etiology of Guillian Barrรฉ Syndrome
- Causative agents
It occurs 2 - 4 weeks after a benign febrile illness:
- 2/3 of cases follow a respiratory or gastrointestinal infection
- Campylobacter infection 20 - 30%
- Others e.g. CMV, EBV, HSV
GBS has been reported to follow:
- Vaccinations
- Epidural anesthesia
- Thrombolytic Agents
Pathogenesis of Guillian Barrรฉ Syndrome
Subtypes of Guillian Barrรฉ Syndrome
CP of Guillian Barrรฉ Syndrome
CP of Guillian Barrรฉ Syndrome
- Motor
CP of Guillian Barrรฉ Syndrome
- Sensory
CP of Guillian Barrรฉ Syndrome
- Autonomic
CP of Guillian Barrรฉ Syndrome
- CNs
INVx for Guillian Barrรฉ Syndrome
INVx for Guillian Barrรฉ Syndrome
- CSF Analysis
INVx for Guillian Barrรฉ Syndrome
- Electrophysiological Studies
Management of Guillian Barrรฉ Syndrome
Management of Guillian Barrรฉ Syndrome
- Indication of PICU Admission
Management of Guillian Barrรฉ Syndrome
- Specific TTT
Management of Guillian Barrรฉ Syndrome
- IVIG
Management of Guillian Barrรฉ Syndrome
- Advantages of IVIG
IVIG is the preferred immunomodulatory treatment as it is
- easier to give
- few side effects
- the treatment can be implemented more quickly
- good outcome as plasmapheresis
Management of Guillian Barrรฉ Syndrome
- regimens of IVIG
Management of Guillian Barrรฉ Syndrome
- Plasmapheresis
Prognosis of Guillian Barrรฉ Syndrome
Incidence of Poliomyelitis
Etiology of Poliomyelitis
Type of Poliovirus
RNA Virus
Serotypes of Poliovirus
There are 3 Serotypes of poliovirus (genus enterovirus)
- Type 1 most frequently associated with epidemics and causes most paralytic manifestations
- Types 2 & 3 usually associated with vaccine associated paralytic polio (VAPP)
MOT of Poliovirus
- Fecal-oral: absorption of poliovirus in the intestinal tract
- Droplet (rare)
Pathogenesis of Poliomyelitis
Study CP, Dx & TTT of Polio
Prevention of Poliomyelitis
Prevention of Poliomyelitis
- Advantages of OPV
- Inexpensive
- Easy to administer
- Produces excellent immunity in the intestine (which helps prevent infection with wild virus in areas where it is endemic)
Prevention of Poliomyelitis
- IPV
- Most industrialized countries have switched to IPV
- which cannot revert
- Either as the sole vaccine against poliomyelitis or in combination with OPV
Risks of OPV
VAPP
Def of VAPP
- They are cases of AFP, which have residual weakness 60 days after onset of paralysis and vaccine related poliovirus is isolated from their stool
Etiology of VAPP
In some recipient of OPV, there is genetic change (<1%) in the VP1 gene of vaccine virus
CP of VAPP
It causes paralysis:
- In recipient (recipient VAPP)
- Among unimmunized close contacts (contact VAPP)
Incidence of VAPP
- 1 case of VAPP occurs after 2.3 million first doses, and after 12 million subsequent doses.
Etiology of Traumatic Neuritis
Traumatic neuritis is caused by injection
CP of Traumatic Neuritis
Atrophy caused by a traumatic injection Never reaches the degree seen in polio
โฆ
Differences in calf circumference usually donโt exceed โฆโฆ.
0.5 - 1.5 cm.
CP of Traumatic Neuritis
- Site
may lead to AFP of the lower extremity.
CP of Traumatic Neuritis
- Associations
- AFP is usually accompanied by pain in the gluteal region or along the affected leg.
- Onset of AFP in the affected lower limb occurs from 1 hour - 5 days after injection in the gluteal region.
- Fever is usually present before the onset of paralysis when injection is given for a pre-existing febrile illness.
CP of Traumatic Neuritis
- Atrophy
Atrophy may appear 40 - 60 days later
Prognosis of Traumatic Neuritis
Gradual recovery with physiotherapy usually occurs within 3 - 9 months
Compare between Poliomyelitis & Traumatic Neuritis in terms of:
- Age
- Reflexes
- Ms Affected
- Prognosis
Def of Myasthenia Gravis
Itโs an autoimmune disease of the neuro-muscular junction (NMJ) characterized by muscle weakness & fatigability that worsens with activity and improves with rest
Etiology of Myasthenia Gravis
Pathogenesis of Myasthenia Gravis
CP of Myasthenia Gravis
INVx for Myasthenia Gravis
INVx for Myasthenia Gravis
- Labs
Acetylcholine receptor antibody assays: +ve in 85 % of cases
- the most helpful diagnostic investigation
INVx for Myasthenia Gravis
- Electrophysiological Studies
- Repetitive nerve stimulation is abnormal with characteristic findings in 60%
INVx for Myasthenia Gravis
- Chest CT
Assessment of thymoma or thymic hyperplasia
TTT for Myasthenia Gravis
Def of Myasthenic Crisis
It is a serious life-threatening condition involving respiratory muscles
TTT of Myasthenic Crisis
Def of Transverse Myelitis
Acute demyelinating disorder of the spinal cord (other parts of CNS can affected)
Incidence of Transverse Myelitis
- Occurs in children aged โฅ 4 years
- Most patients have only one episode of transverse myelitis
Etiology of Transverse Myelitis
Commonly preceded by a viral infection or immunization
Pathogenesis of Transverse Myelitis
Pathogenesis of Transverse Myelitis
- Most Commonly affected Site
- Demyelination usually occurs at the thoracic leve causing problems with leg movement as well as bowel and bladder control
DDx of Transverse Myelitis
CP of Transverse Myelitis
CP of Transverse Myelitis
- Motor
CP of Transverse Myelitis
- Sensory
- Back pain is common at the onset Els Neese
- Sensory level of loss of sensation which is usually thoraci
CP of Transverse Myelitis
- Autonomic
- Bladder and/or bowel incontinence
TTT of Transverse Myelitis
TTT of Transverse Myelitis
- Acute Management
Acute Management of Transverse Myelitis
- 1st Line
Acute Management of Transverse Myelitis
- 2nd Line
Acute Management of Transverse Myelitis
- Supportive Care
Management of bowl & bladder dysfunction
Management of Transverse Myelitis
- Long Term
- Physical & occupational therapy to prevent contracture
- Treatment of underlying cause
Recovery of Transverse Myelitis
Prognosis of Transverse Myelitis
Pathogenesis of Botulism Toxicity
Botulism Toxicity
- Site
(in the colon/ in wounds / in food e.g, honey)
CP of Botulism Toxicity
CP of Botulism Toxicity
- Non-Specific
Dry mouth
CP of Botulism Toxicity
- CN
CP of Botulism Toxicity
- Autonomic
- Paralytic ileus advancing to severe constipation
- Bladder distention advancing to urinary retention
- Orthostatic hypotension
CP of Botulism Toxicity
- Additional Symptoms
- Deep tendon reflexes are absent.
- There is NO sensory loss.
- There is NO fever
- Consciousness is NOT impaired
INVx for Botulism Toxicity
- Toxin detection, serology
- Electromyography (EMG), Nerve conduction study (NCS)
- CSF examination is normal
TTT of Botulism Toxicity
- Antitoxin (Human botulism Ig)
- Complete recovery takes weeks to months
Diffrentiation between Different Types of AFP