3.6.5
Acute Flaccid Paralysis
Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 3, Central Nervous System Conditions.
Clinical Description
Acute onset of weakness or paralysis with reduced muscle tone
Causes:
- Inflammatory: Guillain- Barre syndrome, Transverse myelitis
- Trauma
- Infection: e.g., TB spine, schistosomiasis, enteroviruses, polio
- Tumours: primary or secondary spinal tumours e.g. Burkitt’s Lymphoma
- Toxins: botulinum toxin
Signs and Symptoms
- Rapid onset of weakness, Ascending weakness, Paraplegia, Bulbar weakness, Paresthesia, Stool and urine incontinence, Radicular pain, Autonomic dysfunction
Investigations
- Identify underlying cause, Xray of spine, Stool and urine microscopy, CT or MRI spine
Pharmacological
Objective
- Prevent respiratory and cardiovascular compromise and restore function of the spinal cord
- Assess and manage airway, Breathing and Circulation
- Refer urgently if ascending paralysis
- Physiotherapy and occupational therapy
- Treat underlying cause
Complications
- Respiratory failure, Spinal shock, Pressure sores, Contractures
Complications and Referral Criteria
- Refer urgently if ascending paralysis
- Refer all for diagnostic workup
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