Neobook — clinical reference

This is a neurological emergency. Weakness may involve respiratory muscles with consequent respiratory failure.

DIAGNOSTIC CLUE	LIKELY CONDITION
Perinatal problems/VLBW	IVH/HIE
Loss of acquired skills	Degenerative Disorder
Family history	SMA/Myopathy/Storage Disorder
Dysmorphic	Down’s Syndrome/ Prader Willi Syndrome
Tendon reflex exaggerated	Upper Motor Neuron lesion
Tendon reflex absent	Lower Motor Neuron lesion

Conditions include

Guillain Barre Syndrome: the hallmark of this condition is symmetrical ascending weakness with areflexia. The progression may be rapid and any child who has difficulty coughing, talking or is using accessory muscles to breathe needs to be in a facility where they can be ventilated. The differential includes vaccine associated polio and wild type polio. All cases of Acute Flaccid Paralysis need to be notified with stool samples sent away for virological studies.
Toxins: these may cause altered levels of consciousness. Consider Organosphates where a child has excessive secretions and constricted pupils. A response to atropine (Dose 0.01-0.02 mg/kg) is a useful diagnostic clue. Can be confirmed with low pseudocholinesterase levels.
Botulism: to be considered in the infant or young child with sudden onset generalised weakness.
Weakness with a distinct spinal cord level. This could indicate transverse myelopathy. A distended bladder may be suggestive of this. Needs to have an MRI for confirmation. Discuss with neurologist.

Investigations (Discuss with Neurology about further investigations)

Genetics: If dysmorphic features.
Blood: FBC/CEU/CMP/TSH/Toxic screen/SMN gene
LP: If normal LOC + no focal lesion (D/W consultant)
Stool: Polio virus culture/Enterovirus
Radiology: Cranial imaging may be required

Treatment (A.B.C.)

Treat specific condition. May need airway protection + ventilation especially if Guillaine Barre a concern. If Guillain Barre may need IVIG. Discuss with a consultant.

Sudden Onset Weakness

Drugs mentioned