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liomyelitis, now also caused by the West Nile virus and by enteroviruses other than the polio agent In all these infectious cases the illness is marked by fever, meningoencephalitic symptoms, early pleocytosis in the spinal uid, and purely motor and usually asymmetrical are exic paralysis We have been several times misled by cases of carcinomatous meningitis that caused a subacute and fairly symmetric but mainly distal weakness and appeared similar to GBS An irregular distribution of weakness between proximal and distal parts, the absence of facial weakness and the appearance of symptoms in one limb after another are always suggestive of this type of neoplastic in ltration of nerve roots Sciatica may occur with either process but radicular pain in the arms is unusual in GBS Examination of the spinal uid usually settles the matter Another distinctive problem arises in distinguishing generalized GBS with ophthalmoparesis or the Fisher variant from basilar artery thrombosis The presence of reactive pupils, are exia, and F-wave abnormalities in GBS, and of lively re exes and Babinski signs in the case of brainstem infarction, dependably separates the disorders Ptosis and oculomotor weakness, features of GBS in some severe generalized cases and in Fisher syndrome, may cause confusion with acute myasthenia gravis, but in the latter disease there are no sensory symptoms and the tendon re exes are unimpaired The mandibular muscles remain relatively strong in GBS, whereas the exercised jaw hangs open in myasthenia Botulism may also simulate GBS, but pupillary re exes are lost early in botulism (pupillary paralysis occurs mainly in advanced cases of GBS), and there is usually a bradycardia, which is unusual for GBS Tick paralysis, a disease of children in the United States but affecting both children and adults in Australia, may be nearly impossible to distinguish from GBS unless one nds the tick (page 1034) In addition to an ascending paralysis, both also sometimes cause ataxia and may paralyze eye movements, but sensory loss is not usually a feature of tick paralysis and the CSF protein remains normal Ingestion of shell sh or reef sh contaminated with saxitoxin, ciguatoxin, or tetrodotoxin (ciguatera, neurotoxic shell sh poisoning) is another cause of acute facial-brachial paresthesias, weakness, tachypnea, and iridoplegia lasting a few days symptoms that resemble the cranial nerve variants of GBS A number of neuromuscular disorders in critically ill patients with systemic medical conditions may be dif cult to distinguish from GBS These include a polyneuropathy of critical illness (see further on); an accelerated neuropathy of renal failure that is seen mainly in diabetic patients receiving peritoneal dialysis (both discussed further on); acute hypophosphatemia induced by hyperalimentation; polymyopathy produced by the administration of highdose corticosteroids (page 1237); and the prolonged effects of neuromuscular blocking drugs, resulting in the accumulation of their metabolites in patients under conditions of renal failure and acidosis Episodes of painful paralytic porphyria bear a super cial resemblance to GBS Treatment General medical aspects In severe cases, respiratory assistance and careful nursing are paramount, since the disease remits naturally and the outlook for recovery is favorable in the majority About one quarter of our patients in the recent era of treatment have required mechanical ventilation Since a patient s condition may deteriorate unpredictably and rapidly in the rst days of illness, virtually all but the mildest cases should be admitted to the.

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Go ahead and test the application Leave the name blank, put in an incorrectly formed email address, and click the Send Information button As you can see in Figure 9-14, all of the error messages have been placed in a bullet list You can combine different types of validation, and the error messages are all recognized by the ValidationSummary control When you have no errors, as seen in Figure 9-15, no space is used up by either the validator controls or the ValidationSummary control For applications where you are adding validation after a page has already been designed, you will find that this will save you a huge amount of time because you do not have to reformat the basic design