1. ACUTE FLACCID PARALYSIS
By:Dr.Amena Fatima

2. Acute Flaccid Paralysis
Introduction
GB Syndrome
Differential diagnosis
Approach
Summary

3. 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.

4. 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

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

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

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

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

10. 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

26. 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

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

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

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

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

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

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

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

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

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

36. Acute Flaccid Paralysis

37. Acute Flaccid Paralysis
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