ACUTE FLACCID PARALYSIS By:Dr.Amena Fatima

Acute Flaccid Paralysis Introduction GB Syndrome Differential diagnosis Approach Summary

Acute Flaccid Paralysis Introduction Acute flaccid paralysis one of the common and often challenging neurological disorders Timely diagnosis and appropriate management –key factors in outcome.

Acute Flaccid Paralysis Guillain-Barre Syndrome Clinical Manifestations Rapidly evolving ascending areflexic motor paralysis evolves over hours to days subjective sensory symptoms Facial weakness Autonomic dysfunction

Acute Flaccid Paralysis Antecedent events Precceding infections -70% Respiratory GIT Vaccination

Acute Flaccid Paralysis Pathogenesis Autoimmune T cell &B cell Anti ganglioside antibodies Anti GM1 ,GD1a ,GQ1b etc Demyelination,Axonal damage

Acute Flaccid Paralysis Demyelination leads to conduction block Axonal damage more severe form

Acute Flaccid Paralysis Lab CSF- elevated protein (100-1000mg/dl) normal to <50 cells AlbuminoCytological dissociation Electrophysiology demyelinating/axonal ,mixed.

Diagnostic Criteria -GBS Required Supportive Progressive weakness of 2or more limbs Relative symmetry Areflexia/hyporeflexia Cranial nerve/facial weakness Course <4 weeks Absence of fever at presentation Exclusion of other causes Nil/mild sensory involvement CSF-Albuminocytological dissociation electrophysiology

Acute Flaccid Paralysis Treatment Earlier the better Intravenous immune globulin 2gr/kg over 5 days Plasmapheresis 40-50ml/kg four times alternate day

Acute Flaccid Paralysis Supportive care Monitor vitals Ventilatory support Autonomic dysfunction DVT prophylaxis Bedsore Bowel/bladder

Acute Flaccid Paralysis Prognosis 70-85% recover over weeks to months Mortality<5% Relapses-5-10%

Acute Flaccid Paralysis Differential Dignosis Hypokalemia Acute transverse myelitis Toxins Vasculitis Poliomyelitis Porphyrias

Acute Flaccid Paralysis Botulism Myasthenia gravis Rabies Diptheria paralysis Bites Critical illness neuropathy Stroke

Acute Flaccid Paralysis Approach Histoty Duration Onset Fever Constitutional symptoms Preceeding illness,similar episodes Dog bite

Acute Flaccid Paralysis General examination Pallor Nails Rash Gums,Throat Thyroid Joint deformities Bite marks

Acute Flaccid Paralysis Respiration single breath count chest expansion breathing pattern Heart rate fluctuation Blood pressure

Acute Flaccid Paralysis Cranial nerves Fundus Eoms Facial weakness Bulbar function Hypoglossal nerve

Acute Flaccid Paralysis Motor power reflexes coordination Sensory present/absent level Bladder/autonomic Spine

Acute Flaccid Paralysis Invesigations CBP,ESR RBS Creatinine Electrolytes CPK CUE Urine PBG/BJP

Acute Flaccid Paralysis RA/ANA ECG ABG CXR USG abdomen NCS Imaging -selective

Acute Flaccid Paralysis Hypokalemia Young age Recurrent Proximal Rare bulbar Hypo/normal reflexes ECG changes-U waves

Acute Flaccid Paralysis Porphyrias Abdominal pain Seizures Psychosis Autonomic dysfunction Sensory variable Urine Colour -PBG

Acute Flaccid Paralysis Acute transverse myelitis sensory level bladder bowel flaccid to spastic change over time girdle/band sensation MRI Spine contrast –spinal cord signal changes

Acute Flaccid Paralysis Poliomyelitis very young age immunization history fever myalgias asymmetry Stool examination

Acute Flaccid Paralysis Rabies h/o dog bite variable incubation period encephalopathy brainstem signs autonomic dysfunction,sphincter inv Clinical ,imaging ,CSF,biopsy –Negrie bodies

Acute Flaccid Paralysis Botulism short history rapid deterioration vision,autonomic dysfunction bulbar dysfunction descending paralysis hypo/normal reflexes Electrophysiology

Acute Flaccid Paralysis Myasthenia Gravis fatigue fluctuation asymmetry Eoms -ptosis bulbar ,respiration RNS,Ach-R ab, CT Chest-thymus

Acute Flaccid Paralysis Bites NMJ features bite marks often symmetrical rapid deterioration

Acute Flaccid Paralysis Diptheria fever sore throat pharynx/palate membrane predominant cranial nerve involvement Throat swab cultures

Acute Flaccid Paralysis Critical illness neuropathy ICU admission multiorgan dysfunction steroids Motor predominat axonopathy

Acute Flaccid Paralysis Vasculitis constitutional symptoms rash,artralgia sensory/sensorimotor asymmetry mononeuritis multiplex

Acute Flaccid Paralysis Stroke bilateral medial medullary syndrome tongue weakness flaccid followed by spastic quadriparesis Normal –NCS Typical MRI Brain

Acute Flaccid Paralysis

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