Approach to flaccid paralysis in the emergency


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Parálisis bulbar
parálisis flácida
síndrome de Guillain Barre
Miastenia gravis
mielitis transversa
enfermedades de la unión neuromuscular
polineuropatía Bulbar palsy
flaccid paralysis
Guillain barre syndrome
Myasthenia Gravis
transverse myelitis
neuromuscular junction diseases

How to Cite

López Barreto, J. C., & Cardenas, J. M. (2023). Approach to flaccid paralysis in the emergency. Interdisciplinary Journal of Epidemiology and Public Health, 5(2), e–9892. (Original work published December 30, 2022)


Introduction: Flaccid paralysis is a cause of consultation in emergency services, with different etiologies, it can be immune-mediated or secondary to systemic diseases, which can lead to quadriparesis and ventilatory failure due to bulbar paralysis.

Objective: To review the initial approach to flaccid paralysis due to neurological syndromes, the pathophysiology, clinical manifestations, diagnosis and treatment of the neurological diseases that make up this entity.

Methods: a critical review of the scientific literature was carried out in MEDLINE, PUBMED, ELSEVIER, SCIENCE DIRECT, filtering results from subject reviews, case reports, cross-sectional studies, controlled clinical trials, meta-analysis and management guidelines with a total of 13934 documents, prioritizing 30.

Results: The main cause of flaccid paralysis is Guillain barre syndrome, followed by systemic diseases and other neurological diseases such as myasthenia gravis or transverse myelitis, signs of respiratory failure must be identified early, diagnosis It is mainly clinical, although there are confirmatory studies, and treatment must be started early and in a timely manner with steroids, immunoglobulin or plasmapheresis, and immunomodulation. Conclusion: Flaccid paralysis is a neurological emergency with different etiologies, warning signs must be recognized, an initial approach and early clinical diagnosis must be carried out to initiate timely treatment.
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Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barré syndrome. Lancet. 2021;397(10280):1214–28.DOI: 10.1016/S0140-6736(21)00517-1

Mohsin N, Asimi R. Clinical profile of acute flaccid paralysis: A study from North India, Kashmir. CHRISMED J Heal Res. 2017;4(1):27. DOI: 10.4103/2348-3334.196059

Latorre R, Purroy F. Hypokalemic periodic paralysis: A systematic review of published case reports. Rev Neurol. 2020;71(9):317–25. DOI: 10.33588/RN.7109.2020377

Rohkamm R. Neurological Syndromes. Color Atlas of Neurology. 2004. 206–210 p.

Gutiérrez-. Enfermedades De La Motoneurona Clasificacion De Las Enfermedades De La Motoneurona. Barcelona Prous Sci. 1999;3–11.

Barohn RJ. A PATTERN RECOGNITION APPROACH TO THE PATIENT WITH A SUSPECTED MYOPATHY. Neurology [Internet]. 2014;32(3):1–42. Available from: DOI 10.1016/j.ncl.2014.04.008.A

Jackson CE, Barohn RJ. A Pattern Recognition Approach to Myopathy. Contin Lifelong Learn Neurol [Internet]. 2013 Dec;19(December):1674–97. Available from: DOI: 10.1212/01.CON.0000440665.72169.87

Gilhus NE, Tzartos S, Evoli A, Palace J, Burns TM, Verschuuren JJGM. Myasthenia gravis. Nat Rev Dis Prim [Internet]. 2019;5(1):1–19. Available from: DOI: 10.1038/s41572-019-0079-y

Bershad EM, Feen ES, Suarez JI. Myasthenia gravis crisis. South Med J. 2008;101(1):63–9. DOI: 10.1590/0004-282X20130108

Donofrio PD. Guillain-Barré Syndrome. Contin Lifelong Learn Neurol. 2017;23(5, Peripheral Nerve and Motor Neuron Disorders):1295–309.

Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, et al. Diagnosis and management of Guillain–Barré syndrome in ten steps. Nat Rev Neurol [Internet]. 2019;15(11):671–83. Available from:

Rodríguez Y, Rojas M, Pacheco Y, Acosta-Ampudia Y, Ramírez-Santana C, Monsalve DM, et al. Guillain–Barré syndrome, transverse myelitis and infectious diseases. Cell Mol Immunol. 2018;15(6):547–62. DOI 10.1038/cmi.2017.142

Administration F and D. Janssen COVID-19 Vaccine EUA Fact Sheet for Healthcare Providers. 2019;2019(May 2021):1–29.

Salmon DA, Proschan M, Forshee R, Gargiullo P, Bleser W, Burwen DR, et al. Association between Guillain-Barré syndrome and influenza A (H1N1) 2009 monovalent inactivated vaccines in the USA: A meta-analysis. Lancet [Internet]. 2013;381(9876):1461–8. Available from:

Mehta S. Neuromuscular disease causing acute respiratory failure. Respir Care. 2006;51(9):1016–21.

Sibéril S, Elluru SR, Negi VS, Ephrem A, Misra N, Delignat S, et al. Intravenous immunoglobulin in autoimmune and inflammatory diseases: More than mere transfer of antibodies. Transfus Apher Sci. 2007;37(1):103–7. DOI 10.1016/j.transci.2007.01.012

Kes P, Zavoreo I, Lisak M. Guidelines for the use of intravenous immunoglobulin in the treatment of neurologic diseases GUIDELINES FOR THE USE OF INTRAVENOUS IMMUNOGLOBULIN IN THE TREATMENT OF Ad hoc Committee of the Croatian Society for Neurovascular. 2012;(December).

B. Vijay RA. Intravenous Immunoglobulin ( IVIG ). 2022;1–16.

Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher. 2019;34(3):171–354.

Nicolle MW. Myasthenia Gravis and Lambert-Eaton Myasthenic Syndrome. Contin Lifelong Learn Neurol. 2016;22(6):1978–2005.

Gilhus NE. Myasthenia and the neuromuscular junction. Curr Opin Neurol. 2012;25(5):523–9.

Yoganathan K, Stevenson A, Tahir A, Sadler R, Radunovic A, Malek N. Bedside and laboratory diagnostic testing in myasthenia. J Neurol [Internet]. 2022;269(6):3372–84. Available from: DOI: 10.1002/jca.21705

Godoy DA, Mello LJV de, Masotti L, Napoli M Di. The myasthenic patient in crisis: an update of the management in Neurointensive Care Unit. Arq Neuropsiquiatr [Internet]. 2013 Sep;71(9A):627–39. Available from: DOI 10.1590/0004-282X20130108

Sanders DB, Wolfe GI, Benatar M, Evoli A, Gilhus NE, Illa I, et al. International consensus guidance for management of myasthenia gravis: Executive summary. Neurology. 2016;87(4):419–25.

Scott TF, Frohman EM, De Seze J, Gronseth GS, Weinshenker BG. Evidence-based guideline: Clinical evaluation and treatment of transverse myelitis: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology [Internet]. 2011 Dec 13;77(24):2128–34. Available from:

Frohman EM, Wingerchuk DM. Transverse Myelitis. N Engl J Med [Internet]. 2010 Aug 5;363(6):564–72. Available from:

Sellner J, Lüthi N, Schüpbach WMM, Gebhardt A, Findling O, Schroth G, et al. Diagnostic workup of patients with acute transverse myelitis: Spectrum of clinical presentation, neuroimaging and laboratory findings. Spinal Cord. 2009;47(4):312–7. DOI 10.1038/sc.2008.143

Beh SC, Greenberg BM, Frohman T, Frohman EM. Transverse Myelitis. Neurol Clin. 2013;31(1):79–138. DOI 10.1016/j.ncl.2012.09.008

Krishnan C, Kaplin AI, Pardo CA, Kerr DA, Keswani SC. Demyelinating disorders: Update on transverse myelitis. Curr Neurol Neurosci Rep. 2006;6(3):236–43. DOI 10.1007/s11910-006-0011-1

Wein S, Knipe H, Gaillard F et al. Transverse myelitis. Transverse myelitis Ref Artic (Accessed 12 Jan 2023).

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