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Edit Comment Close Premium member Presentation Transcript Slide 1: Don’t BE depressed Slide 2: ‘Arise, awake and stop not till the goal is reached!’ Dr.Shivaprakash sosale chandrashekar : Dr.Shivaprakash sosale chandrashekar PERIPHERAL NERVOUS SYSTEM Slide 5: Upper Motor Neuron (UMN) vs Lower Motor Neuron (LMN) Syndrome UMN syndrome LMN Syndrome Type of Paralysis Spastic Paresis Flaccid Paralysis Atrophy No (Disuse) Atrophy Severe Atrophy Deep Tendon Reflex Increase Absent DTR Pathological Reflex Positive Babinski Sign Absent Superficial Reflex Absent Present Fasciculation and Absent Could be Fibrillation Present Slide 6: Anterior horn cell Peripheral nerve* Neuromuscular junction Muscle skin *motor and sensory Peripheral Nervous System Disorders – motor impairment : Peripheral Nervous System Disorders – motor impairment Anterior Horn Cell Disorders Spinal Muscular Atrophy (SMA) (genetic) Poliomyelitis (acquired) Peripheral Nerve Disorders Guillain-Barre Syndrome (acquired) Charcot-Marie-Tooth disease (genetic) Neuromuscular Junction Disorders Myasthenia Gravis Infant botulism Muscle Disorders Duchenne and Becker Muscular Dystrophy Slide 8: Two weeks after a viral syndrome, a 9-year-old girl presents to your clinic with a complaint of several days of drooping of her mouth. In addition to the drooping of the left side of her mouth, you note that she is unable to completely shut her left eye. Her smile is asymmetric, but her examination is otherwise normal. This girl likely has ? 1. Guillain-Barré syndrome 2. Botulism 3. Cerebral vascular accident 4. Brainstem tumor 5. Bell palsy Question 3: : Question 3: A 6 year old girl is brought to your office for clumsy gait of 3 days duration. On exam, she is afebrile and ataxic. She has a full right facial palsy. Deep tendon reflexes are hard to elicit at the knees and absent at the ankles. Of the following, the MOST appropriate next step in the evaluation of this child is: Slide 10: A. computed tomography (CT) of the head B. electroencephalography (EEG) C. lumbar puncture D. magnetic resonance imaging of the spine E. urine toxicology screen Guillain-Barre Syndrome (GBS) : Guillain-Barre Syndrome (GBS) Most common ACUTE neuropathy in children Post infectious polyneuropathy – Mainly motor also sensory and autonomic Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) Slide 12: 2/3 report antecedent infection 1-3 weeks prior Infections – GIT-Campylobacter jejuni, H.pylori RS- Mycoplasma pneumoniae West Nail virus ,CMV,EBV,Hepatitis,HSV Vaccines- Rabies ,Influenza,OPV,Meningococcal ETIOLOGY: Guillain-Barre Syndrome (GBS) : Guillain-Barre Syndrome (GBS) Most common cause of rapidly progressive weakness Any age Landry ascending B/L symmetric paralysis (9% with asymmetry) Reflexes reduced or absent “pins and needles” (sensory symptoms) back and hip pain /myalgia + 7% of children with relapse Slide 17: Miller-Fisher variant Areflexia + Ataxia + Ext.ophthalmoplegia CN palsies: (ophthalmoplegia, facial diplegia / “flat affect” / “decreased facial movements Slide 18: Diagnosis of GBS: *CSF (> 1 week) – Inc. protein+ no cells(Albuminocytological dessociation) Nerve Conduction Velocities (NCVs) – reduced & sensory nerve conduction time slow MRI – may show enhancement of spinal roots Sural nerve biopsy-segmental demyelination ,focal inflammation & wallerian degeneration Slide 19: Prognosis: Usually good (~75%), Recovery may take weeks to months, DTR last to recover . Easy fatigue MC Ch.symptom. Poor prognostic signs: Rapidly progressive < 7 days Assisted ventilation Axonal (not just demyelination) – on NCVs as decreased amplitudes Slide 20: Management: No treatment if symptoms minimal IVIG / IFN or Plasmapharesis Steroids not effective For Ch.neuropathic pain –Gabapentin Slide 21: All of the following are features of Guillen –Barre syndrome except –AI96- A)Predominent motor involvement B)Residual disability c) Absence of proteolysis in CSF D)Sparing of bladder function Question 3: : Question 3: A 6 year old girl is brought to your office for clumsy gait of 3 days duration. On exam, she is afebrile and ataxic. She has a full right facial palsy. Deep tendon reflexes are hard to elicit at the knees and absent at the ankles. Of the following, the MOST appropriate next step in the evaluation of this child is: Slide 23: A. computed tomography (CT) of the head B. electroencephalography (EEG) C. lumbar puncture D. magnetic resonance imaging of the spine E. urine toxicology screen Which of the following statements are true regarding guillian barre syndrome : Which of the following statements are true regarding guillian barre syndrome A)Facial nerve palsy occurs B)Proximal muscle weakness C)Areflexia D)Pyramidal signs E)Distal muscle weakness Slide 26: THANK YOU Slide 27: THANK YOU DEPARTMENT OF PEDIATRICS,GMC,MIRAJ Slide 28: Reference : Nelson 18th ed You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.