8 YR , old boy has sudden weakness of lower limbs ,following a brief illness one week ago. he has not received any injections in the recent past. a presumptive dx of GBS was made
what are the Clinical presentations of GBS?
I. Required for Diagnosis
Progressive motor weakness of more than one limb
Areflexia – loss of ankle-jerk reflex and diminished knee and biceps
reflexes suffice, if other features are consistent with the diagnosis
II. Strongly Supportive of the Diagnosis
Progression – weakness may develop rapidly but cease to progress after 4 weeks; roughly 50% will plateau within 2 weeks,80% by 3 weeks, and 90% after 4 weeks
Relative symmetry
Mild sensory symptoms or signs
Cranial nerve involvement; facial weakness develops in about half of patients
Autonomic dysfunction
Absence of fever at the onset of neurologic symptoms
Recovery – usually recovery begins 2–4 weeks after progression ceases; it may be delayed for months
Variants
Fever at onset of symptoms
Severe sensory loss with pain
Progressive phase longer than 4 weeks
Lack of recovery or major permanent residual deficit
Sphincter dysfunction – sphincters are usually spared, although
transient bladder paralysis may occur
n CNS involvement
III. Features Casting Doubt on the Diagnosis
Marked persistent asymmetry in motor function
Persistent bowel or bladder dysfunction
Bowel or bladder dysfunction at onset of symptoms
Discrete sensory level
IV. Features that Exclude the Diagnosis
History of recent Hexa carbon abuse
Evidence of porphyria
Recent diphtheria
Features consistent with lead neuropathy and evidence of lead intoxication
A pure sensory syndrome
Definite diagnosis of an alternate paralytic disorder
Superintendent, ICH.