This document discusses chronic inflammatory demyelinating polyneuropathy (CIDP), Guillain-Barré syndrome (GBS), and post-polio syndrome. CIDP is a neurological disorder involving progressive weakness and reduced sensation. GBS is an acute inflammatory polyneuropathy and the most common cause of acute flaccid paralysis. It presents with symmetrical weakness and loss of reflexes. Post-polio syndrome causes muscle pain and new or exacerbated weaknesses in people who had polio decades prior. Management of these conditions includes immunoglobulins, steroids, physical therapy, and lifestyle modifications.

1. Chronic inflammatory
Demyelinating Polyneuropathy
Guillain barre syndrome

2. Learning objectives
• ETIOLOGY
• STAGES
• PRESENTATION
• MANAGEMENT

3. • CIDP is a neurological disorder involving progressive weakness and
reduced senses in arms and legs
• Tingling or no feeling in fingers or toes
• Weakness of arms and legs
• Loss of deep tendon reflexes
• Fatigue

4. • Most common cause of AFP
• Acquired, acute inflammatory (post infective or idiopathic)
polyneuropathy
• Symmetrical flaccid motor weakness, minimal sensory involvement,
autonomic dysfunction
• Rare in infants
• Male to female ratio 1.5 : 1

5. Pathophysiology
• IMMUNE MEDIATED DISORDER
• DEMYELINATING OR DEGENERATIVE AXONAL INJURY
• MULTIFOCAL AREAS OF INFLAMMATION OR DEMYELINATION WITH
CELLULAR INFILTRATES OF MACROPHAGES & LYMPHOCYTES
• RESULTS IN CONDUCTION BLOCK
• INFLAMMATION INVOLVES PERIPHERAL N ,CRANIAL N, DORSAL ROOT,
GANGLIA, SYMPATHETIC CHAIN

6. ETIOLOGY
• ANTIGEN ANTIBODY REACTION AGAINST PERIPHERAL NS
• FOLLOWS RESP , GIT INFECTION
• MYCOPLASMA
• VIRUSES :HEP B, CMV, EBV, MUMPS, MEASELS, INFLUNZA
• CAMPYLOBACTER JEJUNI MOST COMMON

7. STAGES OF GBS
• PROGRESSIVE PHASE : , 6 WKS
• PLATEAU PHASE
• RECOVERY PHASE
• SYMMETRICAL WEAKNESS OF LOWER LIMBS
• ASCENDING SPREAD TO UPPER LIMBS AND CRANIAL NS
• HYPOTONIA, HYPOREFLEXIA LOWER LIMBS
• PLANTERS NORMAL

8. STAGES OF GBS
• PROGRESSIVE PHASE : , 6 WKS
• PLATEAU PHASE
• RECOVERY PHASE
• SYMMETRICAL WEAKNESS OF LOWER LIMBS
• ASCENDING SPREAD TO UPPER LIMBS AND CRANIAL NS
• HYPOTONIA, HYPOREFLEXIA LOWER LIMBS
• PLANTERS NORMAL

9. DIAGNOSIS
• CLINICAL FEATURES
• NCS : CONDUCTION BLOCK, DEMYELINATION, DEGENERATION OF
MOTOR OR SENSORY AXONS
• EMG : RED IN RECRUITMENT , ACTIVE DENERVATION
• CSF : ELEVATED PROTEINS , CELL COUNT NORMAL

10. MANAGEMENT
• Gen Supportive care
• Good medical and nursing care
• ICU admission
• Nutritional support
• Care of bowel and bladder
• Prevention of bedsores and DVT
• Tx of sec bacterial infections
• CIDP- No cure. IVIGs, Multivitamins, Physiotherapy

11. Management
• IMMUNOGLOBULINS (IVIGs) 400 mg/kg 5 days
• STEROIDS : PREDNISONE 2 mg/kg – 2 wks
• PLASMAPHERESIS
PROGNOSIS
• MOST COMMON CAUSE OF DEATH : AUTONOMIC INSTABILITY
• RESP FAILURE
• RECOVERY : 1-6 m

12. SUDDEN INFANT DEATH
SYNDROME

13. • SIDS – sudden death of an infant under 1 year of age
• Also called Crib death
• Usually associated with sleep
• Mostly occurs during first 6 months
• Sudden, unpredictable
• Usually healthy baby before death
• Cannot be explained by review of history, death scene investigation,
autopsy

14. Risk Factors for SIDS
• Placing the baby on his side or stomach to sleep
• Prematurity
• Low birth weight
• Overheating during sleep
• Sleeping on a soft surface
• Family history of SIDS or FTT
• Smoking during pregnancy
• Mother under 20 yrs of age , received no prenatal care

15. Triple Risk Model
• Infant has underlying abnormality (brainstem) making him unable to
respond to low O2 or high CO2 blood levels
• Exposure to triggering event e.g sleeping face down on tummy
• Vulnerable stage in infant’s development i.e first 6 months

16. PREVENTION
• Putting the baby on his back while he sleeps
• Placing baby on tummy while awake
• Sleeping on firm mattress or surface
• Keep babies warm, not too warm
• Baby’s crib in your room for first 6 months
• Avoid bed sharing
• Smoke free environment
• If baby sick, show doctor right away
• Breastfeed the baby

17. POST POLIO SYNDROME

18. POST POLIO SYNDROME
• Poliomyelitis acute viral infection
• Asymptomatic in 90-95 % cases
• Mild illness to rapidly progressive illness – encephalitis, paralysis,
death
• Transmission by orofecal route, perinatal
• Paralytic polio –asymmetric paralysis
• Spinal, bulbar, bulbospinal, encephalitic forms
• Diagnosis mainly clinical, CSF , Viral culture of stool and throat swabs

19. • 30-40% of patients with paralytic polio suffer Post polio syndrome
• 30-40 yrs later
• Muscle pain, exacerbation of existing weakness, development of new
weakness
• Infected with wild type virus
• Risk factors- inc length of time since acute infection, presence of
permanent residual impairment after recovery from acute illness and
female sex.

20. Management
• Energy Conservation. Resting frequently, assistive devices
• Physical Therapy. Muscle strengthening exercises, swimming, aerobics
• Speech Therapy. Compensate for swallowing difficulties, voice
strengthening exercises
• Medications. Pain relievers
• Stay warm
• Avoid falls
• Healthy lifestyle
Prevention: Polio vaccine OPV and IPV