An 18 year old male patient with complaints of tingling and numbness of both feet since 15 days, and both hands since 6 days.

The complete case can be found here

Possible diffrential diagnosis for presenting problems

1. perepheral neuropathy polyneuropathy pattern
  • guillian barrie syndrome
  • thiamine deficieny, b12 deficiency, pyridoxin deficiency, vitamin E deficiency
  • toxins like alchohol, organophosphorus
  • Drugs: Amiodarone Antibiotics (dapsone, isoniazid, metronidazole, ethambutol) Antiretrovirals • Chemotherapy (cisplatin, vincristine, thalidomide) Phenytoin
  • Systemic medical conditions like diabetic neuropathy, sarcoidosis, myxoedema


most likely diagnosis is
Guillian barrie syndrome because of  Distal paraesthesia and pain precede muscle weakness that ascended rapidly from lower to upper limbs and is more marked proximally than distally, suggests guillan barrie syndrome

investigations

CSF analysis
  • protein is raised, but may be normal in the first 10 days.
  • There is usually no increase in CSF white cell count (> 10 × 106 cells/L suggests an alternative diagnosis).

Electrophysiological testing
  • conduction block and multifocal motor slowing, sometimes most evident proximally as delayed F waves.

Antibodies to the ganglioside GM1 are found in about 25%, usually the motor axonal form.

RFT, LFT, complete hemogram to obtain baseline values in this patient
HIV, hepatitis B serology, Hepatitis C serology

Final diagnosis
Nerve conduction study suggested Acute motor and sensory axonal neuropathy.
and the patient showed improvement in 2 days so this is a case of guillian barrie syndrome

Management
Active treatment with plasma exchange or intravenous immunoglobulin improves prognosis.
but cost is a factor to concider


"Nine (11%) patients showed rapid recovery (improvement by two or more Hughes grades within 2 weeks). They often had electrodiagnosis of acute motor axonal neuropathy (AMAN; 67%), preserved tendon reflexes (44%), anti-GM1 antibodies (89%), preceding H influenzae infection (44%), and received immunoglobulin treatment (44%). On the other hand six patients with poor prognosis often had AMAN (100%)"

"The long-term prognosis of GBS appears not to be influenced by treatment options. The long-term improvement of IVIg treated-patients might be due to the self-limitation of GBS per se instead of the IVIg treatment."
effects of IVIg on guillian barrie syndrome:


Supportive measures to prevent pressure sores and deep venous thrombosis are essential.
Regular monitoring of respiratory function (vital capacity) is needed in the acute phase, as respiratory failure may develop with little warning.

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