1. Acute flaccid paralysis (AFP) can present asymmetrically or symmetrically. Asymmetrical AFP may be caused by poliomyelitis or non-polio enteroviruses, while symmetrical AFP may be Guillain-Barré syndrome or transverse myelitis. 2. Important considerations in the evaluation of a child with AFP include differentiating acute infections from post-injection paralysis, obtaining a thorough history of recent vaccinations or infections, and ruling out treatable causes with imaging or lumbar puncture when indicated. 3. Proper management depends on the stage of illness, with the acute stage prioritizing isolation and prevention of paralysis progression, the restoration stage involving physi

1. 1
BY:
Dr, WALAA SALAH
MANAA
SPECIALEST OF PEDIATRIC
‫ـستشفى‬‫م‬‫ـفر‬‫ك‬ ‫ـيات‬‫م‬‫ح‬‫ـيخ‬‫ش‬‫ال‬
Approach to Child with AFP

2. 2

3. 4

4. Asymmetrical Symmetrical Acute hemiplegia
5
AFP

5. Asymmetrical
2-Non polio enteroviruses
1-poliomylitis
3-Post injectional paralysis
4-pseudoparalysis
trauma
Toxic synovitis
osteomyelitis
Symmetrical
1-Guillain Barre syndrom
2-Postdiphtheric paralysis
4-botulism
3-Transverse myelitis
5-Spinal cord compression
6-With ataxia-chorea
7-Rare causes
Rabis -prophyria
Acute hemiplegia
1-infection
2-cardiac
3-hematologic
4-metabolic
5-traumatic
6
AFP

6. 7
Organophosphrous pois
Tick born paralysis

7. 8

8. *Viral disease of AHC
*Affect unvaccinated or partially vaccinated infant and young children.
*Character sudden (hr)-massive-flaccid-(asymmetrical >LL)
*pure motor…….(no sensory loss).
9

9. Spinal polio:
the commonest form.
Asymetrical of LL.
May extend to trunk –U.L. neck.
Respiratory paralysis ( intercostal &
diaphragmatic paralysis).
Spinobulbar polio
weak cry-weak cough-nasal regurge.
10

10. Stage of paralysis
1-Acute stage
( 1st weeks):
*Pt is infectious=(isolation is important).
*Paralysis may extend (observation is
important ).
*No I.M. ( may precipitate more paralysis)
*stage of pediatrician. 11

11. 2-Restoration stage
-( 2 w -6 m ) :
-Gradual but incomplete recovery
-Phsiotherapy 2-3 time per weak.
To prevent muscle wasting & deformity)
-Stage of physiotherapyist
12

12. 3-Stage of residual
-( after 6 m.)
-No further improvement is expected.
-Neglected & severe case (wasting-
shortening-deformities.
-stage of orthopedic surgeon.
13

13. 1960
respirator device, called an
"iron lung."
14

14. 15

15. symmetrical
2-Non polio enteroviruses
1-poliomylitis
3-Post injectional paralysis
4-pseudoparalysis
trauma
Toxic synovitis
osteomyelitis
symmetrical
1-Guillain Barre syndrom
2-Postdiphtheric paralysis
4-botulism
3-Transverse myelitis
5-Spinal cord compression
6-With ataxia-chorea
7-Rare causes
Rabis -prophyria
Acute hemiplegia
1-infection
2-cardiac
3-hematologic
4-metabolic
5-traumatic
16
AFP

16. 2-Non polio enteroviruses
Coxsackieviruses & echoviruses can affect AHC
 acute paralysis
Mild-transient- not massisive.
who?
vaccinated infants-mild paralysis children.
17

17. 3-Post injection paralysis
Paralysis is limited to the limb
where injection is given.
Monoplegic
Radiating pain along the course of
the injured sciatic nerve.
Confused with polio
-the condition ppt by injection .
-But focal nature
-absence of paralysis. 18

18. 4-Pseudo-paralysis
1-Unrecognized trauma (fracture-sprain-contusion).
2-toxic synovitis of hip or knee.
3- acute osteomyelitis.
-Painful limping gait
-focal tenderness
-CNS is free.
19

19. symmetrical
2-Non polio enteroviruses
1-poliomylitis
3-Post injectional paralysis
4-pseudoparalysis
trauma
Toxic synovitis
osteomyelitis
symmetrical
1-Guillain Barre syndrom
2-Postdiphtheric paralysis
4-botulism
3-Transverse myelitis
5-Spinal cord compression
6-With ataxia-chorea
7-Rare causes
Rabis -prophyria
Acute hemiplegia
1-infection
2-cardiac
3-hematologic
4-metabolic
5-traumatic
20
AFP

20. 21

21. 22

22. 1-Guillian barre
syndrome
=(postinfectious polyneuritis).
The most common cause of
acute paralysis in children .
Common > 3yrs.
Preceded by viral infections.
1-2 w. before the onset of
paralysis.
23

23. Character of paralysis
Start in LL few days ascend to trunk- UL
=tetraplegia.
-Affected limb is flaccid + lost tendon reflex.
-Respiratory paralysis may occur & if ,pt may
need mechanical ventilations for weeks.
-Bulbar paralysis 50 % & if, aspiration and
pneumonia.
-Atypical descending paralysis may occur…DD
with botulism
24

24. -Peripheral sensory loss is minimal or absent
-Autonomic disturbance may occur
-Occasionally, initial disturbed consciousness for hr or
few days may occur
-The course is benign with gradual complete
recovery over few weeks or few months
-Relapse may occur 10 %
25

25. investigation
-Nerve conduction velocity……marked reduced.
-CSF examination -
2weeks after onset (increased CSF proteins)
cytoalbuminous dissociation.
-EMG……………….neuropathic pattern.
26

26. 27

27. 28

28. 2-Post diphtheric
paralysis
Toxic polyneuritis
Uncommon nowadays
due to routine
vaccination
1-2 weeks before onset of
paralysis,
History of pharyngeal
diphthria (sore throat +
swollen neck ) or laryngeal
diphthria(stridor ).
29

29. Character of paralysis
Descending
Ocular & bulbar  1-2 w peripheral paralysis
Purely motor & transient.
Course is benign recovery occur
over few weeks
Mimic GBS but ?
Initial bulbar involvement + absence
of sensory involvement
30

30. diphtheria immunization
scheme in London, 1941
31

31. 32
3-

32. Toxic neuro muscular blockade
caused by clostridium
botulinium
33

33. 3 types
1-infant botulism
2-6m
Exposure to soil-house
dust-honey ,or corn syrup
germination of spores in
GIT
2-food borne botulism
Ingetion of improperly
home-preserved food
containing toxins
3-wound botulism
contamination of
wound by cl.bot
organism
34

34. Acute- symmetrical & descending.
Start in bulbar nerves then hr or
days  trunk & limbs
Respiratory paralysis is common & need
prolonged MV for months
Pure motor with no sensory
involvement.
Pt is conscious
afebrile
dry tongue- eyes
35

35. drymouth
slurred
double
breathing
swallowingdrooping
blurry muscle
36

36. Course prolonged over several
weeks
Mimic Atypical descending GBS
…………but?
Nerve conduction velocity is normal
CSF is normal.
EMG is diagnostic
37

37. symmetrical
2-Non polio enteroviruses
1-poliomylitis
3-Post injectional paralysis
4-pseudoparalysis
trauma
Toxic synovitis
osteomyelitis
symmetrical
1-Guillain Barre syndrom
2-Postdiphtheric paralysis
4-botulism
3-Transverse myelitis
5-Spinal cord compression
6-With ataxia-chorea
7-Rare causes
Rabis -prophyria
Acute hemiplegia
1-infection
2-cardiac
3-hematologic
4-metabolic
5-traumatic
38
AFP

38. Is the 2nd most common cause of acute
symmetrical paralysis
39
4-

39. Is segmental dysfunction of the spinal cord
without an evidence of spinal cord
compression
Acute, symmetrical, usually affect only LL
( PARAPLEGIA).
Rarely affect UL  if the lesion is above 5th
cervical segment (QUADRIPLEGIA)
Paralysis is flaccid but over few weeks it
become spastic.
Sensory loss with sensory level over the
trunk.
Autonomic disturbance (urine retention –
stool incontinence) usually present .
40

40. • Course is usually prolonged over several
months.
• Complete recovery occur in 60 %.
CT-MRI-Myelography
is important to differentiate from
acute spinal cord compression
is normal in TM
41
investigation

41. 5-Acute spinal cord compression.
1-Trauma to the back.
2-spinal epidural abscess.
3-vascular anomalies.
4-spinal cord tumors.
Myelography.
CT & MRI spine
42

42. 6-With movement
disorder
hypotonia is usually present
1- Acute cerebellar ataxia ,.
2-rheumatic chorea
43

43. 7-FAMILIAL PERIODIC
PARALYSIS
-Rare.
-AD.
-recurrent episodes of transient paralysis for few hours.
-May be dt hypokalemia.
44

44. 8-porphyria
Rare
Very rare before puberty.
AD.
Recurrent colicky abd. Pain.+transient paralysis.+
painful tender muscle.
45

45. symmetrical
2-Non polio enteroviruses
1-poliomylitis
3-Post injectional paralysis
4-pseudoparalysis
trauma
Toxic synovitis
osteomyelitis
symmetrical
1-Guillain Barre syndrom
2-Postdiphtheric paralysis
4-botulism
3-Transverse myelitis
5-Spinal cord compression
6-With ataxia-chorea
7-Rare causes
Rabis -prophyria
Acute hemiplegia
1-infection
2-cardiac
3-hematologic
4-metabolic
5-traumatic
46
AFP

46. Acute hemipligia ( strock)
47