Guillain Barre' Syndromr, Polyneuritides, Pseudoparalysis, Aseptic meningitis Diseases

Guillain Barre' Syndromr

Guillain Barre' Syndrome: In this there is symmetrical weakness of lower extremities which may ascend to arms, trunk and face. Muscle tenderness with some sensory loss may occur and CSF shows protein/cell dissociation (fewer cells with high protein). Majority recover completely in a few weeks.

Other Infective Polyneuritides: e.g. Mumps, diphtheria, lead etc. Paralysis may occur with or after these conditions. Primary findings are similar to Guillain Barre' syndrome, i.e. mild CSFpleoytosis with elevated protein content is common.

Pseudoparalysis due to scurvy, osteomyelitis, fracture and arthritides is generally easy to differentiate on clinical grounds.

Aseptic meningitis due to other viruses: (1) Paralysis is absent. (2) No bacterial or fungal organisms are found on smear or culture of CSF which may show pleocytosis and increased protein.

Complications 

• Gastrointestinal bleeding, perforation and acute dilatation of stomach.
• Cardiovascular: labile hypertension, tachycardia, arrhythmias, myocarditis and heart failure.
• Pulmonary: respiratory distress, pneumonia and pulmonary edemia.
• Utrinary Tract: transient paralysis of the bladder, calculi and infection.
• Bulbar poliomyelitis.
• Later on atrophy of affected muscles, with contractures and deformities.

Treatment 

• Hospitalization of all patients with paralytic poliomyelitis.
• Strict bed rest.
• Minimal handling of the affected parts. Maintain limbs in neutral position i.e., knee is slightly flexed, hips straight and feet at right angle to the legs with the support of foot board/sand bags.
• Analgesics and mild sedation for relief of pain and restlessness.
• Maintenance of nutrition and hydration.
• Avoidance of constipation and bladder care.
• Keep airway patent by suction and watch for any respiratory distress. Should this occur respiratory support may be required.
• After acute stage is over, physiotherapy should be started. Some children may requir corrective splints or braces.
• Later rehabilitation and orthopedic services may be needed.

Prognosis: The mortality rate in paralytic polio varies from 5-10% and permanent paralysis occurs in  15% of the cases. Mild paralysis may occur in upto 30% of cases.

Prevention: Polio vaccine affords a high degree of protection. Newborn infants whose mothers sera contain antibodies to all serotypes are passively immune for the first few months.