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Approach to sudden paralysis

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Approch to sudden paralysis in case child:

Differential diagnosis:

  • 1)GBS
  • 2)ТМ
  • 3)Poliomyelitis
  • 4) Traumatic neuritis



History:

1)Onset:

  • Sudden onset: TM, traumatic neuritis
  • Gradual onset: GBS (days to weeks), poliomyelitis.
  • Chronic: spinal cord TB, tumor, sequel of encephalitis.


2)Progression of paralysis

  • Ascending: GBS - Sheran She
  • Descending: TM, poliomyelitis -
  • Symmetrical: GBS
  • Asymmetrical: polio


3. Progression of illness

  • Rapidis progresse: GBS polia
  • Stationary. TMspinal cord tumor
  • Slowly: TB, tumor, SMA
  • Improving: CP


4. H /O fever:

  • Fever before paralysis: GBS
  • Fever during paralysis: polio
  • Ongoing fever: TBM. tuberculoma
  • High fever: Brain abscess


5. H/O of trauma: traumatic neuritis

6)H/O vaccination: polio

7. H/O gastroenteritis/RTI: GBS

8. Sensory involvement: TM

9. Features of brain involvement:

  • Seizure
  • Intellectual impairment
  • Altered sensation or behavior problem
  • Speech & cognitive impairment

10. Features of raised ICP: headache, vomiting, blurring of vision - present in ICSOL, brain abscess.

11. Bowel-bladder involvement: TM, GBS (20% transient)

12. Pain, tenderness over neck, shoulder, back, spine; Respiratory/ swallowing difficulty, chocking episodes: GBS.

13. Back pain, loss of sensation with a definite upper level, constipation & retention of urine:TM

14. Fever, headache, neck stiffness, F/O cranial nerve palsy, asymmetric ascending type of paralysis, nasal intonation, swallowing difficulty: polio

15. Deterioration of consciousness: polio