AFP

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BY :Dr, WALAA SALAH MANAA

SPECIALEST OF PEDIATRIC

مـستشفى حمـيات كـفر الشـيخ

Approach to Child with AFP

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Asymmetrical Symmetrical

Acute hemiplegia

AFP

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Asymmetrical

2-Non polio enteroviruses

1-poliomylitis

3-Post injectional paralysis

4-pseudoparalysis

trauma

Toxic synovitisosteomyelitis

Symmetrical

1-Guillain Barre syndrom

2-Postdiphtheric paralysis

4-botulism

3-Transverse myelitis

5-Spinal cord compression6-With ataxia-chorea

7-Rare causes Rabis -prophyria

Acute hemiplegia

1-infection2-cardiac

3-hematologic4-metabolic

5-traumatic

AFP

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Organophosphrous poisTick born paralysis

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*Viral disease of AHC

*Affect unvaccinated or partially vaccinated infant and young children.

*Character sudden (hr)-massive-flaccid-(asymmetrical >LL)

*pure motor…….(no sensory loss).

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Spinal polio : the commonest form.

Asymetrical of LL . May extend to trunk –U.L. neck .

Respiratory paralysis ( intercostal & diaphragmatic paralysis.)

Spinobulbar polio weak cry-weak cough-nasal regurge.

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Stage of paralysis

1-Acute stage ( 1st weeks :)

*Pt is infectious=(isolation is important).

*Paralysis may extend (observation is important ).

*No I.M. ( may precipitate more paralysis)

*stage of pediatrician.

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2-Restoration stage

(-2 w -6 m : )

-Gradual but incomplete recovery

-Phsiotherapy 2-3 time per weak .

To prevent muscle wasting & deformity)

-Stage of physiotherapyist

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3-Stage of residual

(-after 6 m).

-No further improvement is expected .

-Neglected & severe case (wasting-shortening-deformities.

-stage of orthopedic surgeon .

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1960

respirator device, called an "iron lung".

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symmetrical


1-poliomylitis


4-pseudoparalysis

trauma

Toxic synovitis

osteomyelitis

symmetrical



4-botulism


5-Spinal cord compression

6-With ataxia-chorea


Acute hemiplegia



5-traumatic

AFP

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Coxsackieviruses & echoviruses can affect AHC acute paralysis

Mild-transient- not massisive. who?

vaccinated infants-mild paralysis children.

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3-Post injection paralysis

Paralysis is limited to the limb where injection is given.

Monoplegic

Radiating pain along the course of the injured sciatic nerve.

Confused with polio -the condition ppt by injection.

-But focal nature-absence of paralysis .

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4-Pseudo-paralysis

1-Unrecognized trauma (fracture-sprain-contusion).

2-toxic synovitis of hip or knee.

3 -acute osteomyelitis.

- Painful limping gait - focal tenderness

- CNS is free .

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symmetrical


1-poliomylitis


4-pseudoparalysis

trauma

Toxic synovitis

osteomyelitis

symmetrical



4-botulism





Acute hemiplegia



5-traumatic

AFP

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1-Guillian barre syndrome

(=postinfectious polyneuritis.)

The most common cause of acute paralysis in children.

Common > 3yrs.

Preceded by viral infections. 1-2 w. before the onset of paralysis.

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Character of paralysis

Start in LL few days ascend to trunk- UL = tetraplegia.

-Affected limb is flaccid + lost tendon reflex.

-Respiratory paralysis may occur & if ,pt may need mechanical ventilations for weeks.

-Bulbar paralysis 50 % & if, aspiration

and pneumonia.

-Atypical descending paralysis may occur…DD with botulism

-Peripheral sensory loss is minimal or absent

-Autonomic disturbance may occur

-Occasionally, initial disturbed consciousness for hr or few days may occur

-The course is benign with gradual complete recovery over few weeks or few months

-Relapse may occur 10% 25

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investigation

-Nerve conduction velocity……marked reduced.

-CSF examination - 2weeks after onset (increased CSF proteins)

cytoalbuminous dissociation.

-EMG……………….neuropathic pattern.

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2-Post diphtheric paralysis

Toxic polyneuritis

Uncommon nowadays due to routine vaccination

1-2 weeks before onset of paralysis,History of pharyngeal diphthria (sore throat + swollen neck ) or laryngeal diphthria(stridor ).

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Character of paralysis

Descending Ocular & bulbar 1-2 w peripheral paralysis

Purely motor & transient .

Course is benign recovery occur over few weeks

Mimic GBS but?

Initial bulbar involvement + absence of sensory involvement

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diphtheria immunization scheme in London, 1941

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3-

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Toxic neuro muscular blockade caused by clostridium botulinium

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3 types

1-infant botulism 2-6m

Exposure to soil-house dust-honey ,or corn syrup germination of spores

in GIT

2-food borne botulism Ingetion of improperly

home-preserved food containing toxins

3-wound botulism contamination of wound by cl.bot organism

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Acute- symmetrical & descending.

Start in bulbar nerves then hr or days trunk & limbs

Respiratory paralysis is common & need prolonged MV for months

Pure motor with no sensory involvement.

Pt is conscious afebrile

dry tongue- eyes

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drymouth

slurred

double

breathing swallowingdrooping

blurry muscle

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Course prolonged over several weeks

Mimic Atypical descending GBS …………but?

Nerve conduction velocity is normalCSF is normal .

EMG is diagnostic

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symmetrical


1-poliomylitis


4-pseudoparalysis

trauma

Toxic synovitis

osteomyelitis

symmetrical



4-botulism





Acute hemiplegia



5-traumatic

AFP

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Is the 2nd most common cause of acute symmetrical paralysis

4-

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Is segmental dysfunction of the spinal cord without an evidence of spinal cord compression

Acute, symmetrical, usually affect only LL (PARAPLEGIA.)

Rarely affect UL if the lesion is above 5th cervical segment (QUADRIPLEGIA)

Paralysis is flaccid but over few weeks it become spastic.

Sensory loss with sensory level over the trunk.

Autonomic disturbance (urine retention –stool incontinence) usually present .

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• Course is usually prolonged over several months.

• Complete recovery occur in 60 %.

CT-MRI-Myelography

is important to differentiate from acute spinal cord compression

is normal in TM

investigation

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5-Acute spinal cord compression.

1-Trauma to the back.2-spinal epidural abscess.

3-vascular anomalies.4-spinal cord tumors.

Myelography.CT & MRI spine

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6-With movement disorder

hypotonia is usually present

1 -Acute cerebellar ataxia., 2-rheumatic chorea

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7-FAMILIAL PERIODIC PARALYSIS

-Rare.-AD.

-recurrent episodes of transient paralysis for few hours.-May be dt hypokalemia .

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8-porphyriaRare Very rare before puberty.AD.

Recurrent colicky abd. Pain.+transient paralysis+.painful tender muscle.

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symmetrical


1-poliomylitis


4-pseudoparalysis

trauma

Toxic synovitis

osteomyelitis

symmetrical



4-botulism





Acute hemiplegia



5-traumatic

AFP

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Acute hemipligia ( strock)

AFP

Health & Medicine

Transcript of AFP