Demyelination causes eventual full body paralysis in a characteristic ascending fashion starting in the lower limbs and travelling upward to the trunk and upper limbs. Typically involuntary muscles like the diaphragm are affected later in the disorder. It is important to remember that patients have no cognitive decline or decreased level of consciousness.
Peripheral motor weakness occurs due to demyelination and often patients reports rapid onset of muscle weakness 1-3 weeks after an illness or vaccination. Starting in the lower limbs, patients have an unsteady gait and present with decreased deep tendon reflexes (DTR’s).
Patients often present with a sudden onset of weakness with or without paresthesias, which are a burning prickling feeling like pins and needles. This also characteristically occurs in an ascending fashion in the disorder.
Involvement of cranial nerves may cause double vision in patients due to paralysis of the muscles which have motor control of the eyes, called ophthalmoplegia. Pupillary constriction and dilation are not usually affected.
Involvement of cranial nerve VII the facial nerve often causes difficulty speaking or dysarthria. Ensure to get a proper history of the progression of symptoms to understand progression of symptoms to rule out a stroke.
In early stages the motor function of the muscle of mastication are weakened causing decreased ability to chew foods. Later, involvement of cranial nerves IX the glossopharyngeal and X the vagus are often involved and cause this disorder to present with difficulty swallowing (dysphagia). Be sure to assess the level of dysphagia and adjust the care plan as needed. These patients are at high risk for aspiration and may require special interventions for feeding.
If patients have cranial nerve involvement, they may present with a labile blood pressure, which is characterized by episodes of hypertension, as well as episodes of hypotension. These must be managed independently.
As loss of muscle tone occurs throughout the body these patients present with loss of bowel and bladder sphincter control. Remember careful consideration in maintaining skin integrity in these patients as they will be temporarily immobile.
Priorities involve continuous assessment and preparation for respiratory emergencies. Considerations include frequent assessments, management of secretions with suctioning if needed, keeping intubation equipment at the bedside, and considering the need for mechanical ventilation.
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