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Guillen barre syndrome

guillen barre syndrome , traumatic neuritis

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Guillen barre syndrome

  1. 1. ACUTE FLACCID PARALYSIS
  2. 2. • GULLAIN BARRE SYNDROME • TRAUMATIC NEURITIS
  3. 3. • Common cause of AFP in children • AUTO IMMUNE • Rapidly progressive • Symmetric polyradiculoneuropathy • Occur at any age • 2/3 rd patient have an infection within 6 week prior to symptom onset- URTI / gastroenteritis
  4. 4. CLINICAL FEATURES • A/c onset of symmetrical ascending weakness • More in distal muscles • Distal parasthesia & pain precede muscle weakness • Facial and bulbar weakness commonly develop • Involvement of respiratory muscles – ¼ th cases – ventilatory support
  5. 5. • Deep tendon reflexes are diminished • Hypotonia • Sensory involvement • Dysautonomia • Tachycardia, arrythmia , bladder dysfunction, labile blood pressure, impaired thermoregulation • Weakness reaches a max in 4 wks- gradual recovery over weeks to month
  6. 6. SUB TYPES • a/c inflammatory demyelinating polyradiculoneuropathy • a/c motor axonal neuropathy • a/c motor and sensory neuropathy • a/c sensory neuropathy • a/c pandysautonomia • Miller fisher syndrome
  7. 7. • Miller fisher syndrome • ophthalmological abnormalities • Ataxia • areflexia
  8. 8. INVESTIGATION • C/F • ELECTROPHYSIOLOGICAL STUDIES • CSF examination
  9. 9. • CSF protein is raised • CSF white cell count is normal(albumincytologic dissociation) or below 50 cells / mm₃ • Electrophysiological studies and CSF study nl – first week of illness
  10. 10. • Eletrophysiology • Absent F responses or H reflexes , Reduced compound muscle action potential or sensory nerve action potential - axonal forms • Prolonged distal latencies, reduced conduction velocities, abnormal temporal dispersion, &conduction blocks- demyelinating types
  11. 11. TREATMENT • IMMUNOTHERAPY – IVIG 2g/kg over 2-5 days • Plasma exchanges– within 2-4 wks of onset • Indicated Non ambulatory patient • Sev d/s , IVIG therapy(if initiated with in 2 wks from onset) hastens recovery as much as PE
  12. 12. • General supportive care • Cardio respiratory care • Physical therapy • Nutritional management • Management of neuropathic pain • Care of bladder and bowel • Prevention of DVT
  13. 13. TRAUMATIC NEURITIS
  14. 14. TRAUMATIC NEURITIS • Defined as inflammation of nerve after injury • Progression to complete paralysis is hours to 4 days • No onset of fever • Flaccidity is acute and asymmetric • Hypotonia and deep tendon reflexes are diminished • Pain in gluteal region • No cranial nerve invovement
  15. 15. • CSF is normal • No bladder or bowel involvement • Nerve conduction velocity at 3 week is abnormal • Sequelae at 3 months – moderate atropy in affected limb
  16. 16. GBS TRAUMATIC NEURITIS fever May hav prodromal illness absent symmetry Symmetrical asymmetric sensations variable May be impaired in the distribution of affected nerve Respiratory insufficiency May be present absent Cranial nerves Usually affected absent Radicular signs present absent Bladder bowel complaints Transient ,d/t autonomic dysfunction absent Nerve conduction abnormal abnormal CSF Albumino cytologic dissociation normal M RI spine Usually normal normal
  17. 17. THANK U….

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