Acute Flaccid Paralysis

Posted by e-Medical PPT
Differential Diagnosis of Acute Weakness:
Cerebral: Bilateral strokes, Hysteria…
Cerebellar: Acute cerebellar ataxia syndromes.
Spinal: Compressive myolopathy, Transverse
myelitis….
Peripheral nerve: Acute inflammatory demyelinating
neuropathy, Toxic neuropathy, Diphtheria,
Tick paralysis
Neuromuscular junction: Botulism, Myasthenia Gravis…
Muscle disease: Acute myositis
Acute inflammatory myopathies
Metabolic myopathies,
Periodic paralysis…

Acute Flaccid Paralysis
The sudden onset of generalized flaccid weakness in the absence of symptoms of encephalopathy implicates the motor unit.
AFP is an emergency in which management priorities are to support vital functions and reach a specific diagnosis in a timely manner with a focused history and physical examination.
Guillain-Barré Syndrome.
Poliomyelitis.
Transverse Myelitis.

Guillain-Barré Syndrome
It is an acute idiopathic monophasic acquired inflammatory demyelinating polyradiculoneuropathy.
GBS is the most common cause of acute flaccid paralysis in healthy infants and children.

GBS…Pathophysiology
Immune mediated disease.
There is no known genetic factors.
Two third of cases follow a respiratory or GI infection.
Campylobacter infection is the most common, but other organisms include CMV, EBV, HSV, Enteroviruses,…
Guillain-Barré syndrome has been reported to follow
vaccinations
epidural anesthesia
thrombolytic agents

The main lesions are acute inflammatory demyelinating polyradiculopathy, with acute axonal degeneration in some cases, particularly those following campylobacter infection.
Avariety of autoantibodies to gangliosides have been identified especially with axonal forms of the disease.

Clinical Features
Usually 2 - 4 weeks following respiratory or GI infection.
The classic presentation:
Fine paresthesias in the toes and fingertips.
Lower extremity weakness: symmetric & ascending.
Gait unsteadiness.
Inability to walk.
Respiratory muscles involvement.
Neuropathic pain… low back pain.
Cranial Neuropathy:
Facial nerve is most commonly affected, resulting in
bilateral facial weakness..

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