Acute flaccid paralysis. Causes, investigation, management

This document includes all information about acute flaccid paralysis.

1. Learning objectives Definition Causes Clinical findings Diagnostic approach Investigations Management

2. Definition Acute flaccid paralysis is defined as:
sudden onset of weakness (<4 wks ) and floppiness in any part of the body in a child less than 15 yrs of age Acute ’ : Rapid progression from onset to maximum ‘ Flaccid ’ : Loss of muscle tone, ‘floppy’ Absence of spasticity or other upper motor neuron signs ‘ Paralysis ’ : Weakness, loss of voluntary movement

3. Symptoms

4. Investigations MRI spine CSF examination EMG/NCV
STOOL examination
CPK
Serum K level Xray spine for paravertebral abscess in TB

5. Management Initial Management Assess vitals Respiratory care : Detect and manage respiratory muscle weakness: irritability, sweating, poor feeding, shallow resp. efforts, reduced chest expansion. Bulbar weakness detection and management : voice change, poor cr y , difficulty in swallowing or choking on feeds Managing cardiova scular Rule out snake bite Rule out spinal cord pathology

6. Specific therapy

7. Traumatic neuritis Management is entirely supportive Hypokalemic paralysis Correction of potassium levels. Poliomyelitis Management is mainly focused on meticulous supportive care with physiotherapy, ambulation and prevention of deformities.   Compressive myelopathy Spinal immobilization, neurosurgical intervention, steroids.

8. Dd's The 4 most common differential diagnosis in a case of AFP are: Poliomyelitis Guillain Barre Syndrome Acute Transverse Myelitis Traumatic Neuritis

9. Polio Guillain-Barré syndrome Traumatic neuritis Transverse myelitis Installation of paralysis 24 to 48 hours onset to full paralysis From hours to ten days From hours to four days from hours to four days Fever at onset High, always present at onset of flaccid paralysis, gone the following day Not common Commonly present before, during and after flaccid paralysis rarely present Flaccid paralysis Acute, usually asymmetrical, principally proximal Generally acute, symmetrical and distal Asymmetrical, acute and affecting only one limb acute, lower limbs, symmetrical Muscle tone Reduced or absent in affected limb Global hypotonia Reduced or absent in affected limb Hypotonia in lower limbs Deep-tendon reflexes Decreased to absent Globally absent Decreased to absent Absent in lower limbs early hyperreflexia late

10. Polio Guillain-Barré syndrome Traumatic neuritis Transverse myelitis Sensation Severe myalgia, backache, no sensory changes Cramps, tingling, hypoanaesthesia of palms and soles Pain in gluteus, hypothermia Anesthesia of lower limbs with sensory level Cranial nerve involvement Only when bulbar involvement is present Often present, affecting nerves VII, IX, X, XI, XII Absent Absent Respiratory insufficiency Only when bulbar involvement is present in severe cases, enhanced by bacterial pneumonia Absent Sometimes Autonomic signs & symptoms Rare Frequent blood pressure alterations, sweating and body temperature fluctuations Hypothermia in affected limb Present Cerebro -spinal fluid Inflammatory Albumin-cytologic dissociation Normal normal or mild increase in cells