Acute flaccid myelitis: Difference between revisions

 
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==Background==
==Background==
*Polio-like illness, subset of [[transverse myelitis]]
*[[Polio]]-like illness, subset of [[transverse myelitis]]
*More common in children
*More common in children
*Likely caused by:
*Likely caused by:
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*Acute onset, focal [[weakness]] of 1 or more extremity
*Acute onset, focal [[weakness]] of 1 or more extremity
*Decreased muscular tone
*Decreased muscular tone
*Absent or hypoactive reflexes
*Absent or hypoactive [[reflexes]]
*Rarely have numbness, but may have some neuropathic pain
*Rarely have [[numbness]], but may have some [[neuropathic pain]]
*[[Fever]] and other symptoms of infection by causative virus (e.g. [[URI]] symptoms, [[gastroenteritis]])
*[[Fever]] and other symptoms of infection by causative virus (e.g. [[URI]] symptoms, [[gastroenteritis]])
*In severe cases:
*In severe cases:
**Bulbar dysfunction (dysphagia, dysarthria, dysphonia, facial weakness, ptosis)
**Bulbar dysfunction ([[dysphagia]], [[dysarthria]], [[dysphonia]], [[facial weakness]], ptosis)
**Respiratory muscle weakness
**[[respiratory failure|Respiratory muscle weakness]]
**Autonomic instability, arrythmias if cervical lesion present
**Autonomic instability, [[arrhythmias]] if cervical lesion present
*Paralysis usually maximal at 3-5 days after onset
*Paralysis usually maximal at 3-5 days after onset


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==Evaluation==
==Evaluation==
[[File:MRI Brain and Spinal Cord in a child with Acute Flaccid Myelitis.png|thumb| <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234096/</ref>]]
*Evaluate for other causes of symptoms (e.g. [[HSV]], [[bacterial meningitis]], [[Guillain-Barre syndrome]])
*Evaluate for other causes of symptoms (e.g. [[HSV]], [[bacterial meningitis]], [[Guillain-Barre syndrome]])
*CSF: Pleocytosis (WBC count >5 cells/mm<sup>3</sup>), +/- elevated protein
*[[LP|CSF]]: Pleocytosis (WBC count >5 cells/mm<sup>3</sup>), +/- elevated protein
*MRI: spinal cord lesion, largely restricted to gray matter, spanning one or more spinal segments
*MRI: spinal cord lesion, largely restricted to gray matter, spanning one or more spinal segments
<small>(Spinal cord lesions may not be present on initial MRI if performed within the first 72 hours of onset of acute limb weakness.)</small>
**Spinal cord lesions may not be present on initial MRI if performed within the first 72 hours of onset of acute limb weakness.
 
[[File:MRI Brain and Spinal Cord in a child with Acute Flaccid Myelitis.png|thumb <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234096/</ref>]]


==Management<ref>http://www.cdc.gov/acute-flaccid-myelitis/downloads/acute-flaccid-myelitis.pdf</ref>==
==Management<ref>http://www.cdc.gov/acute-flaccid-myelitis/downloads/acute-flaccid-myelitis.pdf</ref>==
*Report suspected cases to CDC/department of health
*Report suspected cases to CDC/department of health
*Respiratory:
*Respiratory:
**Consider intubation for airway protection if evidence of bulbar dysfunction
**Consider [[intubation]] for airway protection if evidence of bulbar dysfunction
**Consider NIPPV if evidence of respiratory muscle weakness (by clinical exam, hypoxia, hypercarbia, vital capacity <15 mL/kg, or NIF <30)
**Consider [[biPAP|NIPPV]] if evidence of respiratory muscle weakness (by clinical exam, hypoxia, hypercarbia, vital capacity <15 mL/kg, or NIF <30)
*Treat neuropathic pain
*Treat [[neuropathic pain]]
*Elevate head of bed >30 degrees
*Elevate head of bed >30 degrees
*No evidence of benefit from [[corticosteroids]], [[IVIG]], plasmapheresis, or antivirals as of yet
*No evidence of benefit from [[corticosteroids]], [[IVIG]], plasmapheresis, or antivirals as of yet
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==External Links==
==External Links==
 
*https://wwwn.cdc.gov/nndss/conditions/acute-flaccid-myelitis/case-definition/2018/
https://wwwn.cdc.gov/nndss/conditions/acute-flaccid-myelitis/case-definition/2018/


==References==
==References==

Latest revision as of 09:16, 24 October 2020

Background

Clinical Features[1]

Differential Diagnosis

Weakness

Evaluation

  • Evaluate for other causes of symptoms (e.g. HSV, bacterial meningitis, Guillain-Barre syndrome)
  • CSF: Pleocytosis (WBC count >5 cells/mm3), +/- elevated protein
  • MRI: spinal cord lesion, largely restricted to gray matter, spanning one or more spinal segments
    • Spinal cord lesions may not be present on initial MRI if performed within the first 72 hours of onset of acute limb weakness.

Management[3]

  • Report suspected cases to CDC/department of health
  • Respiratory:
    • Consider intubation for airway protection if evidence of bulbar dysfunction
    • Consider NIPPV if evidence of respiratory muscle weakness (by clinical exam, hypoxia, hypercarbia, vital capacity <15 mL/kg, or NIF <30)
  • Treat neuropathic pain
  • Elevate head of bed >30 degrees
  • No evidence of benefit from corticosteroids, IVIG, plasmapheresis, or antivirals as of yet

Disposition

  • Admit
  • Consider ICU admission for:
    • Respiratory muscle weakness
    • Bulbar weakness causing impaired airway protection
    • Altered mental status
    • Autonomic instability
    • Cervical lesion on MRI
    • Rapidly progressive course

See Also

External Links

References