AFP Flashcards by Ahmed Farag

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Etiology of Acute Flaccid Paralysis

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Etiology of Acute Flaccid Paralysis

Spinal Cord

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Acute transverse myelitis
Trauma

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Etiology of Acute Flaccid Paralysis

AHCs

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Poliovirus & polio vaccination
Other neurotropic viruses e.g. CMV, EBV, HSV

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Etiology of Acute Flaccid Paralysis

Peripheral Nerves

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Guillain Barré syndrome
Critical illness neuropathy
Toxic neuropathy (arsenic, lead)
Diphtheritic neuropathy

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Etiology of Acute Flaccid Paralysis

NMJ

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Myasthenia gravis
Botulism
Organophosphate poisoning
Snakebite

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Etiology of Acute Flaccid Paralysis

Muscles

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Inflammatory myopathies
Critical illness myopathy

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Etiology of Acute Flaccid Paralysis

Muscle Membrane

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Familial periodic paralysis
2ry hypokalemic paralysis

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Introduction to Guillian Barré Syndrome

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Etiology of Guillian Barré Syndrome

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Etiology of Guillian Barré Syndrome

Causative agents

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It occurs 2 - 4 weeks after a benign febrile illness:

2/3 of cases follow a respiratory or gastrointestinal infection
Campylobacter infection 20 - 30%
Others e.g. CMV, EBV, HSV

GBS has been reported to follow:

Vaccinations
Epidural anesthesia
Thrombolytic Agents

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Subtypes of Guillian Barré Syndrome

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CP of Guillian Barré Syndrome

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CP of Guillian Barré Syndrome

Motor

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CP of Guillian Barré Syndrome

Sensory

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CP of Guillian Barré Syndrome

Autonomic

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CP of Guillian Barré Syndrome

CNs

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INVx for Guillian Barré Syndrome

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INVx for Guillian Barré Syndrome

CSF Analysis

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INVx for Guillian Barré Syndrome

Electrophysiological Studies

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Management of Guillian Barré Syndrome

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Management of Guillian Barré Syndrome

Indication of PICU Admission

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Management of Guillian Barré Syndrome

Specific TTT

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Q

Management of Guillian Barré Syndrome

IVIG

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Management of **Guillian Barré Syndrome** - Advantages of IVIG

IVIG is the preferred immunomodulatory treatment as it is - easier to give - few side effects - the treatment can be implemented more quickly - good outcome as plasmapheresis

Management of **Guillian Barré Syndrome** - regimens of IVIG

Management of **Guillian Barré Syndrome** - Plasmapheresis

Prognosis of **Guillian Barré Syndrome**

INVx for **Myasthenia Gravis**

INVx for **Myasthenia Gravis** - Labs

Acetylcholine receptor antibody assays: +ve in 85 % of cases - the most helpful diagnostic investigation

INVx for **Myasthenia Gravis** - Electrophysiological Studies

- Repetitive nerve stimulation is abnormal with characteristic findings in 60%

INVx for **Myasthenia Gravis** - Chest CT

Assessment of thymoma or thymic hyperplasia

TTT for **Myasthenia Gravis**

Def of **Transverse Myelitis**

Acute demyelinating disorder of the spinal cord (other parts of CNS can affected)

CP of **Transverse Myelitis**

CP of **Transverse Myelitis** - Motor

CP of **Transverse Myelitis** - Sensory

- Back pain is common at the onset Els Neese - Sensory level of loss of sensation which is usually thoraci

CP of **Transverse Myelitis** - Autonomic

- Bladder and/or bowel incontinence

TTT of **Transverse Myelitis**

TTT of **Transverse Myelitis** - Acute Management

Acute Management of **Transverse Myelitis** - 1st Line

Acute Management of **Transverse Myelitis** - 2nd Line

Acute Management of **Transverse Myelitis** - Supportive Care

Management of bowl & bladder dysfunction

Management of **Transverse Myelitis** - Long Term

* Physical & occupational therapy to prevent contracture * Treatment of underlying cause

CP of **Botulism Toxicity**

CP of **Botulism Toxicity** - Non-Specific

Dry mouth

CP of **Botulism Toxicity** - CN

CP of **Botulism Toxicity** - Autonomic

* Paralytic ileus advancing to severe constipation * Bladder distention advancing to urinary retention * Orthostatic hypotension

CP of **Botulism Toxicity** - Additional Symptoms

* Deep tendon reflexes are absent. * There is NO sensory loss. * There is NO fever * Consciousness is NOT impaired

INVx for **Botulism Toxicity**

* Toxin detection, serology * Electromyography (EMG), Nerve conduction study (NCS) * CSF examination is normal

TTT of **Botulism Toxicity**

* Antitoxin (Human botulism Ig) * Complete recovery takes weeks to months