AMAN superficial. Tendon reflexes are usually absent. More

AMAN is entirely a motor form of
neuropathy. In contrast to AIDP, in which tendon reflexes are inva- riably
absent, some patients with AMAN develophyperreflexiaduring the early recovery
phase or even at the peak of illness.(14,15) Autonomic dysfunction
is rarely observed and is mild if present.The pattern of recovery in AMAN is
somewhat different from that in AIDP. In general, recovery from the axonal
degeneration takes place much longer time than the recovery from demyelination.
However,the mean recovery times of AMAN and AIDP are similar.(16) In
contrast to the relatively uniform speed of recovery among patients with AIDP,
two of recovery are found for patients AMAN: some patients recover quickly
within days, and others experience slow and poor recovery.(17) The
slow recovery pattern is due to extensive axonal degeneration, where as the
rapid recovery may be caused by the resolution of functional nerve conduction
failure at the nodes of Ranvier.(16,17) AMSAN is an axonal disorder
similar to AMAN, but the sensory nerves are also involved.

 

 Acute
InflammatoryDemyelinating Polyneuropathy (AIDP)

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In AIDP, proximal as well as distal
muscles of the limbs are involved, usually the lower extremities the upper (ascending
paralysis); the trunk, inter costal, neck and cranial nerves may be affected later.
In addition to the paralysis of the four limbs, patients with AIDP more
frequently have involvement of sensory nerves than patients with AMAN. Sensory
loss occurs to a variable degree and, when present, deep sensation tends to be
more affected than superficial. Tendon reflexes are usually absent. More than
half of patients complain of pain and an aching discomfort in the muscles,
mainly those of the hips, thighs and back.(18) Moreover, AIDP is
often associated with a variety of autonomic involvement. Some AIDP patients
show a fluctuating heart rate (sinus tachycardia and bradycardia) and blood
pressure (hypertension and hypotension). Consequently, the management of cardiovascular
dysfunction is particularly importantin the treatment of patients with AIDP
because the dysfunction may cause sudden death. Urinary retention occurs in
approximately 15% of patients soon after the onset of weakness but
catheterization is seldom required for more than a few days.(18)

 

 Miller Fisher Syndrome

 

MFS has distinct immunological and
pathological features. Clinically, the triad of ophthalmoplegia, ataxia and are
flexia is characteristic. If the diagnosing physician is aware of this unique
combination of clinical manifestations, then a diagnosis is easily made. The
natural prognosis of MFS is generally good and specific immune treatment
appears not to be indicated, unless the patient has concomitant GBS.(19)