Guillain–Barré syndrome (GBS)

(aka: Landry–Guillain–Barré–Strohl syndrome:

• Most common cause of acute flaccid paralysis
• Rapidly progressive ascending paralysis & areflexia
• Autonomic dysfunction, CSF albumin-cytologic dissociation.
• The sensory and motor systems may be equally affected. 
• The paralysis moves rapidly from lower to upper areas.

Differential diagnosis:

• Myasthenia gravis: Intermittent & worsened by exertion.
• Multiple Sclerosis: CNS demyelination, hyperreflexia, multiple lesions on MRI, oligoclonal bands in CSF.
• Botulism: Descending weakness fixed dilated pupils, food/wound toxin exposure & prominent cranial nerve dysfunction with normal sensation.
• Tick paralysis: Ascending paralysis but spares sensation.
• West Nile virus: Headache, fever, & asymmetric flaccid paralysis but spares sensation.
• Transverse myelitis: Pain, weakness, abnormal sensation, urinary dysfunction, sensory level, hyperreflexia, spinal cord lesion on MRI.
• CIDP: Chronic progression, relapses, requires long-term immunotherapy.
• Spinal Cord Compression: Hyperreflexia, sensory level, MRI shows mass or compression.

 

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Lower extremity edema

Lower extremity edema is a multifactorial clinical condition characterized by the abnormal accumulation of interstitial fluid within the subcutaneous tissues of the lower limbs. Clinically, it often presents as visible swelling, which may be either pitting or non-pitting, depending on the underlying etiology. The pathophysiology involves a complex interplay of mechanisms, including increased capillary hydrostatic pressure, decreased oncotic pressure, lymphatic obstruction, and increased capillary permeability. The differential diagnosis is broad, encompassing systemic causes such as congestive heart failure, chronic kidney disease, and hepatic dysfunction, as well as localized factors including venous insufficiency, lymphedema, and trauma. A thorough history and physical examination, complemented by appropriate diagnostic studies such as duplex ultrasonography and laboratory testing, are essential to identify the underlying cause and to inform appropriate management strategies. 

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Palm Rashes

Common features and patterns:

• Color:

1. Red or erythematous: Common in inflammatory or allergic reactions.
2. Purple or purpuric: May suggest vascular or hematologic issues, such as small blood vessel inflammation (vasculitis).
3. White or hypopigmented: Seen in fungal infections or depigmentation disorders.
4. Brown or hyperpigmented: May occur in chronic skin conditions or post-inflammatory hyperpigmentation.

• Texture:

1. Flat (macular): Rash appears as flat, discolored spots.
2. Raised (papular or nodular): Bumps that may be small or large.
3. Scaly or flaky: Seen in psoriasis or fungal infections.
4. Smooth or shiny: Can occur in viral rashes or early dermatitis.

• Moisture:

1. Dry and cracked: Common in eczema or chronic irritation.
2. Moist or oozing: May suggest infection, blistering, or acute contact dermatitis.

• Distribution:

1. Symmetrical: Seen in systemic causes like eczema, psoriasis, or drug reactions.
2. Localized: Often indicates contact dermatitis or insect bites.
3. Peripheral patterns: Rashes that concentrate around the edges of the palms can be seen in certain fungal infections.

• Associated Symptoms:

1. Itching: Common in eczema, scabies, or allergic reactions.
2. Pain or burning: Suggests irritation, infection, or vascular issues.
3. Blisters: Seen in contact dermatitis, hand-foot-and-mouth disease, or bullous skin conditions.
4. Peeling or desquamation: Seen after infections (e.g., scarlet fever) or in conditions like Kawasaki disease.

• Causes & Features:

1. Contact Dermatitis: Red, itchy patches, sometimes with vesicles or blisters.
2. Atopic Dermatitis: Chronic, itchy, scaly rash; may worsen with exposure to irritants.
3. Psoriasis: Thick, scaly, silvery patches, often with well-defined edges.
4. Hand-Foot-and-Mouth Disease: Small, red spots or blisters on palms, soles, and sometimes around the mouth.
5. Fungal Infections (Tinea Manuum): Asymmetric scaling and redness, often with peeling.
6. Scabies: Small, red papules with linear burrows, typically between fingers.
7. Drug Reactions: Diffuse rash that can affect the palms, often accompanied by systemic symptoms.

 

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