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GBS. .pptx
1. COMPREHENSIVE CLINICAL CLASS
ACUTE FLACCID PARALYSIS
Mentor: Prof.S R CHANDRA
Retired Professor,
NIMHANS, Bengaluru.
Presenter: Dr.Ashray S Patel
1st year PG, Pediatrics,
BMCRI, Bengaluru.
2. GENERAL DETAILS:
• NAME : Mr.XYZ
• AGE : 15 years
• GENDER: Male
• First born to non-consanguineous parents
• ADDRESS : KR Market, Bengaluru
• RELIGION: Hindu
• INFORMANT : Self and reliable
• DOA: 6.09.20
• DOE: 6.09.20
3. CHIEF COMPLAINTS:
• Fever with productive cough 2 weeks back.
• Tingling sensation over the feet for 3 days.
• Weakness in both the Lower Limbs for 2 days.
4. HISTORY OF PRESENTING ILLNESS:
• A 15 year old boy was apparently normal 2 weeks back when
he developed sudden onset, high grade, intermittent fever,
child being active in the inter-febrile period, lasted for 3
days. Fever was associated with cough with moderate
expectoration, yellow colour sputum, non foul smelling, not
blood tinged and relieved in 5 days.
No associated chills & rigors.
No pain abdomen, loose stools, vomiting, burning
micturition.
No history of irritability, headache, neck stiffness, confusion
during the illness.
5. • The boy now complaints of tingling sensation over the feet since two
days following which he developed weakness of both the lower limbs
since the past two days, which he noticed yesterday morning as
heaviness of both the lower limbs following which the weakness has
been gradually progressive from inability to climb
upstairs/downstairs, inability to get up from the floor, repeated falls
on attempting to walk with twisting of ankles, slipping of chappals to
the present stage of unable to move both the lower limbs.
No difficulty in combing hair, in buttoning & unbuttoning the shirt was
noticed.
No difficulty in rolling over bed, getting up from bed, raising head and
holding neck was noticed.
6. • No history of reduced sensations or pain over the face or
body.
• No history of urinary incontinence or retention, syncopal
attacks.
• No involuntary movements were present.
• No history of difficulty in taking food to mouth, swaying on
attempting to walk, giddiness.
• No history of fatiguability or fluctuating weakness.
• No history of blurring of vision, double vision, impaired
sensation of smell, drooling of saliva, deviation of angle of
mouth, loss of taste sensation, impaired hearing, difficulty in
swallowing, change in voice.
7. • No history of any breathing difficulty.
• No present history of fever, myalgia, arthralgia, ear pain or discharge,
skin lesions, neck pain, irritability, seizures, altered sensorium.
• No history of pain abdomen, photosensitivity, skin rashes.
• No history of any recent trauma, wound or consumption of
improperly preserved food items.
• Child is vaccinated for polio & has not received any recent
vaccination.
8. PAST HISTORY:
• No history of similar complaints in the past.
• No history of any other medical disorders.
9. TREATMENT HISTORY:
• He had taken over the counter medications for his fever and cough
two weeks back details of which are not known.
10. Antenatal, Natal & Post Natal History:
• He was born to a 25 year old primi mother at 38 weeks period of
gestation by Normal Vaginal Delivery. Antenatal period was
supervised, Mather had received TT injection & had taken iron, frolic
acid, calcium supplements.
• He cried immediately after birth, weighed 2.5kg. Immediate post
Natal and Neonatal periods were uneventful; breastfeeding was
initiated within an hour of birth & exclusively breastfed for 5 months.
11. • DEVELOPMENTAL HISTORY: all domains of development were
achieved at appropriate age.
• IMMUNIZATION HISTORY: Immunized upto date according to NIS.
• DIET HISTORY: He consumes a mixed diet with no calorie & protein
deficits.
13. PERSONAL HISTORY:
Consumes a mixed diet.
Appetite normal
Sleep : No change in pattern of sleep
Bowel and Bladder habits: regular
Denies any deleterious habits.
Socioeconomic Status:
Kuppuswamy scale class 3
14. SUMMARY
15 year old boy of birth order 1, born of non consanguineous
marriage, Full term normal vaginal delivery, belonging to class 3
Kuppuswamy Scale, all developmental domains achieved
appropriate for age & fully immunized was brought to the OPD
with complaints of Fever & Cough 2 weeks back; Acute onset,
Symmetrical, Proximal & Distal Lower Limb weakness progressing
to inability to move both the limbs from the past two days.
No history of sensory, autonomic involvement, no similar history in
family and no other medical conditions.
I would like to think of Guillain-Barre Syndrome, Acute
Inflammatory Demyelinating Polyneuropathy Subtype.
15. EXAMINATION:
The boy is Conscious, Cooperative; Well oriented to Time, Place
and Person. He looks well nourished.
The boy has been bought in a wheel chair & is unable to get up
from sitting position.
Vitals:
• PR: 76bpm
• BP: 112/78mmHg
• RR: 18 breathes per min
• Temperature: 98.6 degree Fahrenheit
16. HEAD TO TOE EXAMINATION:
Pallor: not present
Icterus: not present
Cyanosis: not present
Clubbing: not present
Lymphadenopathy: not present
Edema: not present
No Neuro cutaneous markers, skin rashes
17. NERVOUS SYSTEM EXAMINATION:
HIGHER MENTAL FUNCTIONS:
Conscious, Alert & Cooperative.
Appearance & Behaviour: Normal
Oriented to time, place & person.
Attention span: Normal
Language: Normal
Speech : Normal
Memory : Immediate, recent , remote intact
Intelligence : Normal
Lobar functions : Normal.
18. CRANIAL NERVE RIGHT LEFT
I Normal Normal
II Visual acuity: 6/6
Visual Field :Normal
Pupil : Round, Regular & Reactive
Color vision : Normal
Fundus : fundal glow present
Visual acuity: 6/6
Visual Field :Normal
Pupil : Round, Regular & Reactive
Color vision : Normal
Fundus : fundal glow present
III,IV,VI Pupillary reflexes: present
EOM full range of movement
Pupillary reflexes: present
EOM full range of movement
V Sensory: Intact
Motor: Intact
Jaw Jerk: Absent
Sensory: Intact
Motor: Intact
Jaw Jerk: Absent
19. CRANIAL NERVE LEFT RIGHT
VII Normal Normal
VIII Normal by ticking watch test Normal by ticking watch
test
IX,X Palatal movements present and
equal
Palatal movements
present and equal
XI Normal Normal
XII Normal Normal
21. TONE:
PARAMETER LEFT RIGHT
Upper limb
I. Flexor
II. Extensor
Normal
Normal
Normal
Normal
Lower Limb
I. Flexor
II. Extensor
Hypotonia
Hypotonia
Hypotonia
Hypotonia
30. No signs of meningeal Irritation
Gait: Couldn’t examine.
Skull & Spine: Normal
31. OTHER SYSTEM EXAMINATION:
Cardiovascular Examination :
S1S2 heard in all areas.
No added sounds /murmurs.
Respiratory Examination:
Chest movements equal bilaterally
Normal vesicular breath sounds in all areas
No added sounds
Per abdomen examination:
Soft non tender abdomen
No palpable organomegaly
