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------=_NextPart_01C793DD.21199A50 Content-Location: file:///C:/48FE5993/TheEvaluationandManagementofAcuteParalysis_files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C793DD.21199A50 Content-Location: file:///C:/48FE5993/TheEvaluationandManagementofAcuteParalysis_files/slide0275.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The North American Study of Betaseron in Secondary-Progressive Multi= ple Sclerosis
<= span style=3D'font-size:111%'>The Evaluation and Management of Acute Paralysis
Douglas R. Jeffery M.D.,Ph.D.
Wake Forest University School of Medicine
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IyvZyVK2spa9LGYzq9nNQnYcnv0saEMr2tGStrSmPS1qU6va1bK2ta59LWxjK9vZ0ra2tr0tbnOr 293ytre+/S1wgyvc4RK3uMY9LnKTq9zlMre5zn0udKMr3elSt7rWvS52s6vd7XK3u979LnjDK97x kre85j0vetOr3vUiNyAAOy== ------=_NextPart_01C793DD.21199A50 Content-Location: file:///C:/48FE5993/TheEvaluationandManagementofAcuteParalysis_files/slide0295.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The North American Study of Betaseron in Secondary-Progressive Multi= ple Sclerosis
Presentation
= lPatie= nts present with acute or subacute loss of muscle strength lMay i= nvolve lower extremities or both upper and lower extremities lSenso= ry complaints are common and may help to identify etiology lThe p= resence of bowel or bladder involvement is often helpful in diagnosis =
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lHisto= ry of preceeding infection may be helpful
------=_NextPart_01C793DD.21199A50 Content-Location: file:///C:/48FE5993/TheEvaluationandManagementofAcuteParalysis_files/master03_image001.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/AECAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAIAAQD5 AQEAgAAAAAD//wIUjI+py+0Po5y02ouz3rz7D4bi2BQAOx== ------=_NextPart_01C793DD.21199A50 Content-Location: file:///C:/48FE5993/TheEvaluationandManagementofAcuteParalysis_files/slide0289.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The North American Study of Betaseron in Secondary-Progressive Multi= ple Sclerosis
General Princi= ples
lAll such cases should be regarded as true neurologi= c emergencies
lWeakness may progress rapidly and may be irreversible
lIf weakness is due to cord compression the extent o= f weakness present at the time of definitive therapy will remain
lProgression can be halted but this will not aid in recovery
lBe aware of the possibility of respiratory failure = in cases of GBS
lRapid, accurate diagnosis is essential
------=_NextPart_01C793DD.21199A50 Content-Location: file:///C:/48FE5993/TheEvaluationandManagementofAcuteParalysis_files/slide0296.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The North American Study of Betaseron in Secondary-Progressive Multi= ple Sclerosis
= = Distinguish between weakness arising from <= /span>CNS sources versus PNS
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lSenso= ry level is strong evidence for a CNS source
<= span class=3DBB style=3D'position:absolute;left:-3.81%;top:.22em'>lDistr= ibution of weakness (restricted to lower extremities)
lReflex asymmetry upper versus lower extremities (spinal shock)
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lIn GB= S, reflexes are lost very early in all limbs
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lPrese= nce of a Babinski sign
lThe involvement of bowel and bladder is strongly suggestive of a CNS source (spinal cord)
------=_NextPart_01C793DD.21199A50 Content-Location: file:///C:/48FE5993/TheEvaluationandManagementofAcuteParalysis_files/slide0297.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The North American Study of Betaseron in Secondary-Progressive Multi= ple Sclerosis
= = Differential Diagnosis of Acute Paralysis of Peripheral Nervous System Origin
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lGulli= an Barre Syndrome
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lHypok= alemic Periodic Paralysis
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lBotul= ium intoxication
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lTick paralysis
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lOrgan= ophosphate intoxication
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lMyast= henia Gravis
------=_NextPart_01C793DD.21199A50 Content-Location: file:///C:/48FE5993/TheEvaluationandManagementofAcuteParalysis_files/slide0298.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The North American Study of Betaseron in Secondary-Progressive Multi= ple Sclerosis
Early Warning Signs
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lMild = lower extremity weakness
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lMay t= ake the form of fatiguability of strength
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lInabi= lity to urinate or urinary incontinence
<= span class=3DBB style=3D'position:absolute;left:-3.79%;top:.22em'>lSudde= n onset of symmetric numbness and parasthesias
lPain:= either localized or more severe radiating in a myotomal distribution
------=_NextPart_01C793DD.21199A50 Content-Location: file:///C:/48FE5993/TheEvaluationandManagementofAcuteParalysis_files/slide0299.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The North American Study of Betaseron in Secondary-Progressive Multi= ple Sclerosis
Objective Signs of Spinal Cord Involvement<= /div>
= lWeakn= ess!!  Proximal lower extremity weakness= and distal upper extremity weakness
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lPost = void residual volume greater than 100 cc
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lSenso= ry level to pin prick or other tactile stimuli
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lImpai= red rectal sphincter function
lRefle= xes that are asymmetric between upper and lower extremities
------=_NextPart_01C793DD.21199A50 Content-Location: file:///C:/48FE5993/TheEvaluationandManagementofAcuteParalysis_files/slide0301.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The North American Study of Betaseron in Secondary-Progressive Multi= ple Sclerosis
Acute Paralysi= s of CNS Origin
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lWill = almost always be due to spinal cord pathology
<= span class=3DBB style=3D'position:absolute;left:-3.75%;top:.22em'>lFirst= exclude the presence of a surgically treatable lesion
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lLocal= ize lesion on the basis of neurologic exam
<= span class=3DBB style=3D'position:absolute;left:-3.82%;top:.22em'>lImagi= ng is emergent and MRI is by far the best modality
lIf an= MRI cannot be carried out a CT scan may be useful but is much less sensitive to most forms of pathology
------=_NextPart_01C793DD.21199A50 Content-Location: file:///C:/48FE5993/TheEvaluationandManagementofAcuteParalysis_files/slide0316.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The North American Study of Betaseron in Secondary-Progressive Multi= ple Sclerosis
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= = Structural Lesions Associated with Acute Paralysis
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lMetas= tatic tumor
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lEpidu= ral abscess
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lEpidu= ral hematoma
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lHerni= ated disc
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lPrima= ry spinal cord tumor
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lHemat= omyelia
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lArter= iovenous malformation
------=_NextPart_01C793DD.21199A50 Content-Location: file:///C:/48FE5993/TheEvaluationandManagementofAcuteParalysis_files/slide0324.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The North American Study of Betaseron in Secondary-Progressive Multi= ple Sclerosis
Cervical Disk Herniation
= = lMay r= esult in significant spinal cord compression with acute or subacute paralysis lIn cases of suspected cervical cord injury including di= sc = herniation the neck should be immobilized lNo attempt at ph= ysical therapy should be made until the anatomy has been defined by MRI lThe usual presentation is that of subacute weakness with = very brisk lower extremity reflexes
<= span style=3D'visibility:hidden'>l
------=_NextPart_01C793DD.21199A50 Content-Location: file:///C:/48FE5993/TheEvaluationandManagementofAcuteParalysis_files/slide0325.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The North American Study of Betaseron in Secondary-Progressive Multi= ple Sclerosis
Clinical Case<= /div>
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>l64 yr= old male presents with diffuse weakness
lExami= nation reveals power is 3/5 throughout upper and lower extremities
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lC4 se= nsory level
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lPost = void residual 450 cc
<= span class=3DBB style=3D'position:absolute;left:-4.21%;top:.22em'>lRefle= xes are trace throughout
------=_NextPart_01C793DD.21199A50 Content-Location: file:///C:/48FE5993/TheEvaluationandManagementofAcuteParalysis_files/slide0321.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The North American Study of Betaseron in Secondary-Progressive Multi= ple Sclerosis
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