A Simple Guide to Atrial Fibrillation I

A Simple Guide to Atrial Fibrillation I
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What is Atrial Fibrillation?
---------------------------------

Atrial Fibrillation is a heart condition where the disordered electrical impulses of the atrial muscle leads to irregular electrical impulses to the ventricular heart muscles resulting in irregular heart beats.


Who is at risk of Atrial Fibrillation?
-----------------------------------------

1.Age: 8% of people over 80 has AF

2.family history of AF increases risk by 30%.

What is the cause of Atrial Fibrillation?
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Atrial Fibrillation is caused by underlying heart conditions such as:

1.Primary heart diseases:

a.coronary artery disease

b.mitral stenosis

c.mitral regurgitation

d.hypertrophic cardiomyopathy

e.pericarditis

f.congenital heart disease

g.previous heart surgery

2.Hypertension (High blood pressure)

3.Lung diseases such as

a.pneumonia,

b.lung cancer,

c.pulmonary embolism,

d.sarcoidosis

4.Excessive alcohol consumption

5.Hyperthyroidism


What are the Symptoms of Atrial Fibrillation?
------------------------------------------------------------

Atrial fibrillation often do not present with symptoms.

When they do the symptoms are generally non -life threatening:

Symptoms:
-----------

1.fast heartbeat or palpitations

2.Breathlessness

3.fainting

4.chest pain

Signs:
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1.Pulse is fast and irregular in rhythm and strength

2.Angina pectoris(pain over heart area)

3.Congestive cardiac failure with ankle swelling and breathlessness

4.exercise intolerance

5.Abnormal ECG reading with absent P waves and irregular rhythm

6.Underlying heart disease such as hypertension, pericarditis, valvular disease of heart,

7.Underlying systemic disease such as hyperthyroidism, diabetes, stroke


How is diagnosis of Atrial Fibrillation made?
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1. History and physical examination

Palpitations, atrial fibrillation episodes

2. Blood tests:

renal function and electrolytes,
thyroid hormones, thyroid-stimulating hormone,
blood count.

Where there is chest pain,

blood cardiac enzymes and
coagulation tests are also done

3.Electrocardiogram

a.absence of P waves,
b.irregularity of R-R interval due to irregular conduction of impulses

4.Echocardiography

transthoracic echocardiogram is done in newly diagnosed AF to detect

valvular heart disease ,
left and right atrial size,
left ventricular size and function,
peak right ventricular pressure ,
presence of left ventricular hypertrophy
pericardial disease

5. Chest X-ray

chest X-ray is generally only performed if a pulmonary cause of atrial fibrillation is suggested,

6.Transesophageal echocardiogram

transesophageal echocardiogram (TEE) is done to detect thrombus formation

7.Ambulatory holter monitoring

A holter monitor is a heart monitor which can be worn by the patient to check the heart rate and heart rhythm for 24 hours.

It can detect presence of AF.

8.Exercise stress testing

A threadmill test can gauge the heart rate in response to exertion.

A Simple Guide to Osteomyelitis

A Simple Guide to Osteomyelitis
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What is Osteomyelitis?
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Osteomyelitis is an infection of the bone substance by pyogenic bacteria and fungus.


What causes Osteomyelitis?
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The most causes of Osteomyelitis is

1.Staphylococcus aureus bacteria(80%).

Other bacteria involved are:

2.Streptococci Group A & B

3.Enterobacter species including E.Coli

4.Haemophilus influenzae

5.Pneumococci

6.Serratia marcescens

Systemic mycotic (fungal) infections may also cause osteomyelitis.

1.Blastomyces dermatitidis

2.Coccidioides immitis.

In children,
-------------------
1.the long bones are usually affected in children.

2.Spread of bacteria occurs from the bloodstream from a skin boil, dental abscess, direct injury to the bone.

3.Acute osteomyelitis almost invariably occurs in children.

In adults
---------------

1.injury to the bone is the most common cause.

The bone injury is exposed to local infection in the skin or environment.

Staphylococcus aureus is the most common bacteria in osteomyelitis resulting from bone injury and infection.

Other bacteria such as Pseudomonas aeruginosa, E. coli, and Serratia marcescens, are also common.

2.The vertebrae and the pelvis are the bones most commonly affected in adults.

For osteomyelitis of the vertebral bodies,
50% are due to Staphylococcus aureus,
and the remaining 50%f are due to tuberculosis usually from the lungs.

3.Bone infection in adults are usually due to their lower resistance from

debilitation,
intravenous drug abuse,
infectious root-canal teeth,
other disease or drugs (e.g. immunosuppressive therapy).


What are the symptoms of Osteomyelitis?
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Symptoms:
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1.pain and swelling of the bone

2.fever

3.toxemia

Signs:
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1.Hot tender bones

2.Throbbing pain of bones

3.Abscess and swelling


How do you made the diagnosis of Osteomyelitis?
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Diagnosis of osteomyelitis is often based on:

1.radiologic results showing a translucent center with a ring of sclerosis(hardened bones)

2.Blood and bone cultures are normally required to identify the specific pathogen


What are the complications of Osteomyelitis?
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The complications of Osteomyelitis are:

1.fractures of the bone

2.amyloidosis

3.endocarditis

4.septicemia


What is the treatment of Osteomyelitis?
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1.antibiotic therapy - usually as prolonged treatment lasting a matter of weeks or months.

2.Hyperbaric oxygen therapy has helped in the treatment of refractory osteomyelitis.

3.Immobilization of the bone affected(bed rest, plaster casts,splints)

4.Osteomyelitis may also need surgical debridement to remove pus and damaged bone tissues.

5.Severe cases may lead to the loss of a limb.


What is the prognosis of Osteomyelitis?
----------------------------------------

Prognosis depends on the rapidity of onset of treatment.

The faster the treatment the faster thee cure.

Otherwise the condition may become a chronic illness requiring multiple surgical procedures.

A Simple Guide to Systemic Lupus Erythematosis

A Simple Guide to Systemic Lupus Erythematosis
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What is Systemic Lupus Erythematosis?
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Systemic Lupus Erythematosis is a chronic multisystem autoimmune inflammatory disease which attacks the whole body.

It typically has a butterfly erythematous rash on the face.

It is not contagious.

Who is affected by Systemic Lupus Erythematosis?
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Systemic Lupus Erythematosis is more common in women than in men(9:1 ratio)

Most cases begin at the age range of 15-45 years and occurs less frequently between the age of 45-70 years.

It occurs more frequently in blacks than in white people.


What is the Cause of Systemic Lupus Erythematosis?
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The exact cause of Systemic Lupus Erythematosis is not known.

1.It has been suggested that an autoimmune disease is the main cause of Systemic Lupus Erythematosis disease.

The antibodies produced by the body to fight germs starts to attack the body's own healthy tissue.

2.Psychological problems like stress and anxiety is not a cause of Systemic Lupus Erythematosis but has been known to trigger off the disease.

3.Some cases are induced by medications such as :
hydralazine
procainamide
penicillamine
isoniazid

What are the Symptoms and signs of Systemic Lupus Erythematosis?
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The disease may be mild to severe.

There are also periods of remissions and activity.

During the active stage:
Systemic involvement:
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1.fever

2.anorexia

3.weakness

4.weight loss

5.Lymphadenopathy

Skin Mucosa Involvement:
-------------------------------

1.Typical butterfly erythrematous rash on the face

2.pleomorphic erythrematous and maculopapular lesions on the face, neck and extremeties.

3.Vasculitic nail bed and digital pulp lesions

4.Alopecia, petechiae, bullae, and mucous membrane lesions.

Musculoskeletal System:
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1.Polyarthritis especially small joints of fingers

2.Arthritis milder and non erosive compared to rheumatoid arthritis

3.morning stiffness

4.muscle atrophy and weakness may occur

Eyes:
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1.Retinal hemorrhages and exudates

2.Cytoid bodies

Lungs and Pleura:
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1.Recurrent pleurisy

2.Pleural effusions - small

3.Pulmonary infiltrates

Cardiovascular
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1.Pericarditis

2.Endocarditis with vegetation on the mitral valve especially

Gastrointestinal
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1.Non specific nausea

2.Gastrointestinal ulcers, hemorrhage, necrosis

Renal
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1.Focal membranous nephritis

2.Proliferative nephritis - deposit of autoimmune complexes on capillary walls give rise to typical wireloop changes and epithelial crescents in kidneys resulting in proteinuria, hematuria,and renal failure.

Central nervous system:
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1.Lesions in the brain can cause mental disorders( dementia, psychosis,epilepsy), chores, cerebrovascular accidents,cranial nerve lesions.

2.Peripheral neuropathy of various types

Others:
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1.Thrombotic thrombocytopenic purpura

2.Sjogren's syndrome


How do you make the Diagnosis of Systemic Lupus Erythematosis?
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1.A history of facial butterfly rash, systemic symptoms

2.Blood for ESR, positive ANA(antnuclear Antibodies), LE cells

3.Full blood count for anemia, hemolytic anemia, neutopenia, thrombocytopenia, Coombs' test(usually positive)

4.Renal or skin biopsy

5.X- rays of the chest, abdomen and brain

6.MRI of brain, kidney,

What are the complications of Systemic Lupus Erythematosis?
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1.Severe Dermatitis with discoid lesions (maculopapular in nature)

2.Polyathritis with swelling of joints

3.Anemia

4.Pleural effusions

5.hemorrhage

6.Dementia

7.Renal failure

What is the treatment of Systemic Lupus Erythematosis?
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There is no cure for SLE at the present moment.

Treatment is to relieve symptoms and prevent organs from deteriorating.

Patients with mild symptoms may not need any treatment.

Mild Cases:
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1.short course of antiinflammatory medications such as NSAID or corticosteroids.

2.Rest and freedom from stress

Severe cases:
--------------------
Patients with serious illness which has affected their organ may require stronger medications:
1.high doses of corticosteroids intially intravenously, followed by oral medication whose dosage is reduced slowly to the minimum possible.

Corticosteroids are particularly helpful if internal organs are involved.

Side effects of corticosteroids include gastric problems, thinning of the bones, infection, facial puffiness, cataracts.

2.NSAIDs can reduce inflammation and pain especially in the musculoskeletal system.

Examples of NSAIDs include aspirin, ibuprofen, naproxen.

The side effects are stomach upset, abdominal pain, ulcers or GIT bleeding.

To reduce the side effects, NSAIDs are usually taken with food or H2 antagonist like cimetidine, ranitidine.

3.Antimalarial medication such as Hydroxychloroquine has been particularly effective for SLE patients with fatigue, skin, and joint disease.

Side effects include diarrhea, upset stomach, and eye pigment changes.

Eye pigment changes are rare, but require monitoring by an ophthalmologist

Other antimalarial drugs, such as chloroquine or quinacrine, are considered

4.Treatment for severe skin disease skin disease include dapsone and retinoic acid (Retin-A).

5.immunosuppressive medications are used for treating patients with more severe manifestations of SLE with damage to internal organ(s).

Examples of immunosuppressive medications include methotrexate, azathioprine (Imuran), cyclophosphamide, and cyclosporine .

Side effects are depression of blood cell counts and increased risks of infection and bleeding.

6. mycophenolate mofetil (Cellcept) is very effective in lupus with kidney disease.

It has been able to reverse active lupus kidney disease and maintain remission.

It's lower side effects made it more useful than immunosuppresive drugs.

7.plasmapheresis is used to remove antibodies and other immune substances from the blood to suppress immunity.
It has also help to to remove proteins (cryoglobulins) that can lead to vasculitis.
SLE patients with low platelet levels can have severe bleeding.

7.rituximab is an intravenously infused antibody that suppresses a particular white blood cell, the B cell, by reducing the number in the blood stream.
B cells play a central role in lupus activity, and when suppressed, the disease tends toward remission.

8.omega-3 fish oils could help patients with lupus by decreasing disease activity and possibly decreasing heart disease risk.

9.rest during periods of active disease
Poor sleep quality can cause fatigue in patients with SLE.
Sleep quality and the effect of underlying depression, lack of exercise can have an adverse effect on the health of SLE patients.
It is important to maintain muscle tone and range of motion in the joints.

10.Endstage kidney damage from SLE requires dialysis and/or a kidney transplant.


What is the prognosis of Systemic Lupus Erythematosis?
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The prognosis depends on the severity of the disease

Severe cases with renal disease has poorer prognosis.


How is SLE prevented?
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1.Adequate rest

2. Avoid stress

3. Avoid the sun and use sunscreen.

4.Healthy lifestyle with exercise prevents arthritis

A Simple Guide to Acoustic neuroma

A Simple Guide to Acoustic neuroma
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What are Acoustic neuroma ?
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Acoustic neuroma is a neurofibroma of the eight nerve.


Who are at risk of Acoustic neuroma?
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1.Both sexes are equally affected.

2.Acoustic neuroma occurs more in the 50- 60 age group.

3.It forms 5-10% of the intracranial tumors in adults.


What are the different types of Acoustic neuroma?
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1.Neurofibroma I -
a. Unilateral acoustic neuroma usually
Bilateral acoustic neuromas are not common.

b. occurs in adult life,

c. the tumor involve the 8th nerve,

d. can involve any other cranial nerve or the spinal root.

e.Incidence is usually 90-95%

2.Neurofibroma II -
a. bilateral acoustic neuromas are common

b. occurs before the age of 21.

c. affects the entire nerve

d. autosomal dominant inheritance.

e. Incidence is about 5 to 10%.


What are the Causes of Acoustic neuroma?
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Acoustic neuroma in the adult begins in the Schwann's cells of the vestibular portion of the 8th nerve inside the internal auditory canal.

The tumor grows slowly and can extend into the posterior fossa to occupy the space between the cerebellum and the pons.

Because of its location, it can also compress the 5th, 7th, and less often, the 9th and 10th cranial nerves.

If it grows larger, it may also compress the pons and lateral medulla of the brain, causing blockage of the cerebrospinal fluid and increased intracranial pressure.


What are the symptoms and signs of Acoustic neuroma?
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Symptoms:
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1.unilateral hearing loss

2.tinnitus with unilateral high-pitched ringing sound

3.loss of sense of balance

4.vertigo

5.nausea and vomiting

6.altered gait

7.pressure in the ear

8.rarely headache and altered consciousness.

Signs:
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1.unilateral facial weakness.

2.sensory impairment of the nerve

3.impairment of glandular secretions

4.loss of taste

5.loss of sensation in one side of the face and mouth

6.rarely altered gag or swallowing reflexes.


How are diagnosis of Acoustic neuroma made?
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1.Contrast-enhanced CT will detect almost all acoustic neuromas that are greater than 2.0 cm in diameter

2.MRI with gadolinium enhancement may show even smaller tumors

3.Audiology and vestibular tests are done to check for Nerve versus conduction hearing loss.


What is the Treatment of Acoustic neuroma?
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Treatment of acoustic neuroma is usually by surgery and radiotherapy.

Conservative treatment
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In some cases because the neuroma grow so slowly, the tumor is monitored by annual MRI to see its growth.

This method is common among patients over 70 years old.

In rare cases, acoustical neuroma have been known to disappear spontaneously.

Acoustic neuroma may result in gradual hearing loss and tinnitus.


Surgery
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Surgical removal of acoustic neuroma usually involve microsurgery to remove the tumor.

The superior and inferior vestibular nerves are removed at surgery.

This effectively restores balance in the patient.

Radiation treatment
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Radiotherapy using gamma knife radiosurgery or fractionated stereotactic radiotherapy does not remove the tumor but is able to slow or stop its growth.


What is the Prognosis of Acoustic neuroma?
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Prognosis is good in all early diagnosis and small tumors.

Large tumors may give rise to residual neurolgical damage even afer removal.

A Simple Guide to Glossitis

A Simple Guide to Glossitis
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What is Glossitis?
---------------------------

Glossitis is an acute or chronic inflammatory disease of the tongue which can cause swelling of the tongue and change of colour of the tongue.

The finger like papilla on the surface of the tongue may be lost as a result leading to a smooth tongue.


What are the causes of Glossitis?
----------------------------------------

Bacterial Infections:
----------------------------

1.Gram positive bacteria such as Streptococcus and Staphphylococcus may be painful and lead to upper respiratory tract infection

2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia

Viral infections:
------------------

Herpes simplex

Non-infectious:
----------------

1.Dryness of the mouth and low saliva in the mouth may allow bacteria to grow more readily.

2.Local dental abnormalities, rough edges of teeth ,ill fitting dental appliances, or other trauma to the tongue

3.Tongue Piercings

4.irritants such as tobacco, alcohol, hot foods, and spicy food.

5.Sensitivity to toothpaste, mouthwash, breath fresheners,and dental material

6.Allergies to dyes in candy or preservatives in food.

7.Drug induced such as anticholinergics (cause dryness of mouth), certain blood-pressure medications (ACE inhibitors).

8.Mouth breathing

Systemic diseases:
--------------------

1.iron deficiency anemia, pernicious anemia and other B-vitamin deficiencies

2.Skin diseases such as oral lichen planus, erythema multiforme, aphthous ulcer, pemphigus vulgaris,

3.Systemic diseases such as syphilis, and others.

Genetic
---------------

Occasionally Glossitis may be inherited


What are Signs and symptoms of Glossitis?
---------------------------------------------


Symptoms:

1.Swelling of the tongue

2.Tongue color changes often dark red

3.Pale if caused by anemia.

4.Fiery red if due to vitamin B deficiency

5.Sore and tender tongue

6.Smooth tongue

7.Aphthous ulcers of the tongue

8. Swollen tongue resulting in difficulty with chewing, swallowing, or speaking.

This may require emergency treatment especially if breathing is compromised.


How is the diagnosis of Glossitis made?
------------------------------------------


1.Symptoms and signs of red, swollen and inflamed tongue

2.blood tests (complete blood count, ESR and blood culture)

3.Biopsy of the tongue in rare cases.


What are the complications of Glossitis?
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1.difficulty in breathing and swallowing

2.cervical lymphadenitis - swelling of the neck lymph nodes

3.upper respiratory tract infection


What is the treatment of Glossitis?
------------------------------------


The Main treatment is to reduce inflammation.

1.Good oral hygiene

2.Attend to dental problems

3.Antibiotics and antifungal treatment depending on the organism found

4.Corticosteroids may be given to reduce inflammation

5.For mild cases, topical applications of steroid mouth rinses or creams that is not swallowed are used

6.Underlying causes such as Anemia and nutritional deficiencies must be treated, often by changes in diet or vitamin supplements

7.Avoid irritants such as hot or spicy foods, alcohol, and tobacco to minimize the discomfort.

8.hospitalization may be required if unless tongue swelling is is affecting breathing or swallowing.

What is the prognosis of Glossitis ?
------------------------------------------

Usually very good.

Recurrences are common

What are the Preventive measures taken for Glossitis ?
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1.Avoid smoking

2.Healthy lifestyle with balanced diet and exercise.

3.Regular cleaning of gums and teeth by brushing and flossing

4.Gargling of mouth after meals

5.Regular dental checkups

A Simple Guide to Ichthyosis

A Simple Guide to Ichthyosis
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What is Ichthyosis?
------------------------------------

Ichthyosis is a rare non contagious disease of the keratin of the skin where there is reduction of sweat and sebaceous secretions.

The word Ichthus means fish.

So Ichthyosis means fish like appearance of the skin.


Who is at risk of Ichthyosis?
----------------------------------------------


a family history of ichthyosis


What are the causes of Ichthyosis?
--------------------------------------------------


Most forms of ichthyosis are due to:

A.genetic conditions:
------------------------

1.Ichthyosis vulgaris 95% -autosomal dominant
2.X-linked ichthyosis -sex linked recessive
3.Ichthyosis lamellaris - autosomal recessive usually in newborns
4.Harlequins Ichthyosis -autosomal recessive
5.Bullous Ichthyosis - autosomal dominant

B.Acquired Ichthyosis
----------------------

6.Ichthyosis acquisita occur in :
leprosy,
hypothyroidism,
lymphoma,
sarcoidosis,
Hodgkin disease

7.Xeroderma - is a mild form of ichthyosis, occurs in middle aged and older patients.


What are Signs and symptoms of Ichthyosis?
---------------------------------------------


Symptoms:

1.extensor surface of limbs covered with dry scales(rarely the whole body is covered).

2.axilla and antecubal fossa (elbows,armpits,groins,back of knee)not affected

3.Usually symptoms present in childhood but improve during puberty to becoming worst again in later life.

4.Rashes can be extremely itchy in xeroderma

5.The condition is worse in colder weather.

6.Hair may be thin and dry.

7.Nails are brittle and dry.


How is the diagnosis of Ichthyosis made?
--------------------------------------------------------


1.Appearance of the skin

2.Family history of Ichthyosis

2.Skin biopsy for microscopic examination.


What are the complications of Ichthyosis?
-----------------------------------------------


1.keratisis with corneal and ocular surface disease

2.Ectropion of eyelids due to dehydration

3.Deafness in a Keratitis-Ichthyosis-Deafness (KID)Disease


What is the treatment of Ichthyosis?
------------------------------------


There is no cure for Ichthyosis.

1.Symptomatic treatment with emolient creams such as petroleum jelly my help to hydrate the skin.

2.Itch may be controlled with antihistamines

3.Hydration with propylene glycol solution will help

4.Urea in emulsion creams has also help the dry skin

5.Topical or oral retinoic acid has brought some improvement to the skin.

6.Exposure to the sun may improve or worsen the condition.


What is the prognosis of Ichthyosis ?
------------------------------------------


It is a lifelong condition and need continuous treatment.


What are the Preventive measures taken for Ichthyosis ?
--------------------------------------------------------


There is no known preventive measure for ichthyosis

A Simple Guide to Pityriasis Rosea

A Simple Guide to Pityriasis Rosea
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What is Pityriasis Rosea?
------------------------------------


Pityriasis Rosea is a common non contagious disease which appears as numerous patches of red rash on the trunk of the body.


Who is at risk of Pityriasis Rosea?
----------------------------------------------


All ages and both sex are affected but occurs more between 10 -35 years of age.


What are the causes of Pityriasis Rosea?
--------------------------------------------------


The cause is unknown but a viral infection is suspected to cause it.


What are Signs and symptoms of Pityriasis Rosea?
---------------------------------------------


Symptoms:

1.A single red large patch of rashes or herald patch usually occur 1-20 days on the body before the onset of numerous small patches.

2.sore throat may occur before the onset of rashes

3.Numerous Large patches of red oval-shaped rash on the body may occur on the chest, back and neck.

4. As the rashes subside on the body, they may spread to the groin and extremities like the legs and arms

5.Rashes can be extremely itchy

6.breathlessness

7.low-grade fever

8.headache

9.nausea

10.fatigue.


How is the diagnosis of Pityriasis Rosea made?
--------------------------------------------------------


1.Symptoms and signs of typical herald patch followed by other patches of rashes

2.Skin scraping for microscopic examination.


What are the complications of Pityriasis Rosea?
-----------------------------------------------


1.Fungal infection

2.bacterial infection


What is the treatment of Pityriasis Rosea?
------------------------------------


1.No treatment may be necessary as the illness is self limiting

2.Itch may be controlled with antihistamines

3.Corticosteroid (oral or cream) may help reduce severe itching and inflammation

4.Soap should be avoided because it irritate the skin.

5.Moisturizer is better because of the dry skin

6.UV therapy sometimes help

7.Antibiotics may be given if there is secondary infection.


What is the prognosis of Pityriasis Rosea ?
------------------------------------------


Generally excellent but may recur.


What are the Preventive measures taken for Pityriasis Rosea ?
--------------------------------------------------------


1.Good skin hygiene

2.Healthy lifestyle with balanced diet and adequate sleep.

3.Proper skin care of the body.

A Simple Guide to Guillain-Barre Syndrome

A Simple Guide to Guillain-Barre Syndrome
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What is Guillain-Barre Syndrome?
----------------------------------------

Guillain-Barre Syndrome is a rare autoimmune progressive disease with relatively symmetrical weakness of 2 or more limbs due to neuropathy, areflexia and mild sensory symptoms of not more than 4 weeks duration.

The Guillain-Barre Syndrome is a condition also called acute inflammatory demyelinating polyneuropathy (AIDP).

What causes Guillain-Barre Syndrome?
-------------------------------------------

In Guillain-Barre Syndrome, antibodies produced by the body's immune system attacks the gangliosides of cranial, spinal and peripheral nerve usually after:

1.a nonspecific respiratory or gastrointestinal viral illness

2.infectious mononucleosis

3.Campylobacter jejuni , cytomegalovirus infection

4.vaccination

5.extreme exposure to cold

The result of the antibodies attack on the peripheral nerves is inflammation of myelin and blockage of nerve conduction, resulting in muscle paralysis with sensory or autonomic deficits.


Who is at risk of Guillain-Barre Syndrome?
----------------------------------------------------

Guillain-Barre Syndrome occurs at any age usually at age 30-40.

It occurs more in men than in women.


What are the symptoms of Guillain-Barre Syndrome?
-------------------------------------------------------

The typical feature of Guillain-Barre Syndrome is

1.acute onset of symmetrical muscle weakness in both lower limbs with
ascending progression of the weakness upwards to the arms and face usually within hours or days.

2.the lower cranial nerves can also be affected leading to bulbar weakness, (dysphagia or difficulty with swallowing) and respiratory difficulties. If this happens , hospitalisation is a must.

3.Sensory loss is usually minor with loss of position, numbness or tingling sensation.

4.areflexia or complete loss of deep tendon reflexes is always present.

5.Loss of pain and temperature sensation may be present but mild.

6.pain is a common symptom with deep aching pain usually in the weakened muscles.

7.Autonomic dysfunction such as tachycardia, diarrhea, bladder dysfunction may occur but are usually transient.

8.absence of fever is one of the sign of Guillian Barre Syndrome.
If there is fever, another cause should be suspected.

Recovery usually begins 2-4 weeks after progression of disease stops.

How is the diagnosis of Guillain-Barre Syndrome made?
----------------------------------------------------------------

The diagnosis of Guillain-Barre Syndrome involve

1.History of a rapid onset and progression of ascending motor weakness, areflexia and the absence of fever.

2.physical and neurological examinations for peripheral neurological deficit.

3.cerebrospinal fluid examination-
typical CSF findings show albumino-cytological dissociation,

a. an elevated protein level (100 - 1000 mg/dL)
b. absent pleocytosis (increased cell count)unlike infectious causes.

4.Electromyographic studies and nerve conduction studies may show prolonged distal latencies, conduction slowing, nerve conduction blockage suggestive of demyelination.

5.Computed tomography or MRI may show actual demyelination of the nerve.

What are the complications for Guillain-Barre Syndrome ?
--------------------------------------------------------

1.Progression of nerve involvement to whole body

2.Paralysis of respiratory muscles and swallowing can be life threatening

What is the treatment for Guillain-Barre Syndrome ?
---------------------------------------------------------

Treatment for Guillain-Barre Syndrome may be urgent especially in cases of respiratory distress:

1.Hospitalisation and early intubation with a respirator on standby in case of difficulty in respiration

2.treatment of the underlying cause is started as soon as possible:

a. High dose intravenous immune globulin, which temporarily modifies the immune system and provides the body with normal antibodies from donated blood or

b.plasmapheresis in which abnormal antibodies are removed from the blood.

3.rehabilitation is atrted after the patient is stable and will focus on improving activities of daily living functions such as brushing teeth, washing and getting dressed.

4.physiotherapy to strengthen muscles

5.Speech therapy for speech and awallowing

6. Corticosteroids have no part to play in the treatment of Guillian Barre Syndrome.


What is the prognosis of Guillian-Barre Syndrome?
------------------------------------------------------------

1.With all these new treatments the prognosis for most patients with Guillain-Barre Syndrome is good with 80% recovery within 1 year

2.Some of them may have persistant minor neurological deficits such as areflexia.

3.Some 5% recover but with severe disability involving severe proximal motor and sensory axonal damage with inability of axonal regeneration.

4.About 10% of patients have relapses and are as classified as having chronic inflammatory demyelinating polyneuropathy

5.Death is rare(5%) and may be due to severe paralysis, autonomic dysfunction and other severe pulmonary complications.