Praween Lolekha, MD Thammasat University

1. Acute Peripheral Neurologic disorder Praween Lolekha, MD Thammasat University

9. Neural Control of Breathing Mechanoreceptors -Respiratory muscle -Lungs: Pulmonary stretch receptor Chemoreceptors -Carotid bodies -Aortic bodies Medullary respiratory Center (RC center) CN IX,X CN X -Phrenic n (C3-5) - Intercostal n (T2-T12) Larygopharyngeal m. Bronchoconstrictors CN IX

17. Guillain-Barré syndrome

20. Guillain- Barré syndrome AIDP = Acute inflammatory demyelinating polyneuropathy AMAN = Acute motor axonal neuropathy AMSAN = Acute motor sensory axonal neuropathy MFS = Miller Fisher syndrome (Ophthalmoparesis, ataxia, areflexia) GBS AIDP AMAN MFS AIDP with 2 degeneration AMSAN

39. Pathophysiology

41. Quantitative MG Score

45. “ Myasthenic snarl”

48. Repetitive Nerve Stimulation “ Decrement response”

54. Diagnosis of MG Evaluate for Thymectomy Anticholinesterase Crisis Generalized Occular Low risk If unsatifactory MRI Anticholinesterase Intensive Care Respiratory Infection High risk Improve Thymectomy Prednisolone Immunosuppressive Plasmapheresis / IVIg Not improve

61. Repetitive Nerve Stimulation Posttetanic facilitation - incremental response >200%

67. Pathophysiology

72. Vincent van Gogh

74. Pathway of Haem Synthesis

85. Puffer fish poisoning

91. Acetylcholine in PNS

97. Neurological Respiratory Failure Level of consciousness History of Drugs, Toxic substance Normal consciousness Poor, Unconsciousness Long tract signs Brain stem signs -Brainstem lesion: infraction -Increase ICP -Brain herniation PNS Acute Chronic Polyneuropathy : GBS NMJ : MG crisis Botulism Toxin : Porphyria Tetrodotoxin -Drugs -Metabolic -Infection -Other systems ALS Muscular dystrophy Myopathy Critical illness myopathy,neuropathy Others Other systems Yes No Airway: -COPD, asthma Alveoli: -Pneumonia CNS

99. The END