A cute infective polyneuritis
"Landry Guillain Barre Syndrome"
Aetiology:
- It is due to an allergic or auto-immune reaction secondary to a previous non-specific virus infection.
Clinical picture:
Febrile stage:
- it starts with an influenza-like attack with fever, headache, malaise, pains all over the body with no nervous symptoms.
Latent stage:
- the above symptoms disappear and the patient is free for 1-4 weeks.
Paralytic stage:
- There is acute severe weakness or paralysis starting in the loewr limbs and ascending to involve the trunk and respiratory muscles, followed by the upper limbs muscles.
- Contrary to other types of polyneuropathy, the weakness is proximal more than distal.
- In spite of severe degree of paralysis, wasting is not present early in the disease.
- Sensory impairment may occur resulting in stock and glove hypothesia and deep sensory loss.
- Early in the disease there is tenderness of the calves.
- The cranial nerves are usually involved specially cranial nerves 7,10 resulting in bilateral facial paralysis and bulbar symptoms.
- C.S.F. show cytoalbuminous dissociation.
- Prognosis is good in 85% of the cases where recovery occurs in 3-4 weeks.
Treatment:
1)Absolute rest in bed till the heart rate reaches below 100/min.(i.e. return of the vagal tone).
2)Care of the bulbar muscles by:
2)Care of the bulbar muscles by:
- Frequent suction of secretions feom the pharynx.
- Neostigmine 1 mg hourly I.M.
- Tube feeding in case of phayngeal paralysis.
3)Care of the respiratory muscles by:
- Frequent suction to keep a patient airway.
- Tracheostomy may be needed.
4)Corticisteriods(Prednosone or Prednisolone 60 mg/day).
5)Gamma-globulins and plasmapheresis:
5)Gamma-globulins and plasmapheresis:
- the most recent and effective treatment.
6)Vitamins B1,B6,B12(Trivarol,Tri-B),I.M. daily.
7)A.T.P. 25 mg daily I.M.(Adenoplex).
8)Antibiotics e.g. tetracycline to guard against 2ry infection.
9)Physiotherapy:
7)A.T.P. 25 mg daily I.M.(Adenoplex).
8)Antibiotics e.g. tetracycline to guard against 2ry infection.
9)Physiotherapy:
- Massage.
- Passive and active exercises.
- Proper positioning and electrical stimulation.