Recognition and Management of Acute Flaccid Myelitis in Children |
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| Institution: | 1. Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah;2. Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah;3. Department of Medical Imaging, Primary Children''s Hospital, Salt Lake City, Utah;4. Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah;1. Unit of Pediatric Neurology and Neurodevelopment, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India;2. Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India;3. Pediatric Emergency and Intensive Care Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India;1. Department of Pediatrics, Eulji General Hospital, College of Medicine, Eulji University, Seoul, Republic of Korea;2. Department of Pediatrics, Pusan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea;3. Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;1. Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Japan;2. Department of Orthopaedic Surgery and Traumatology, Tanta University, Tanta, Egypt;1. Department of Emergency Medicine, Naval Medical Center, Portsmouth, Virginia;2. School of Medicine, Eastern Virginia Medical School, Norfolk, Virginia;3. Department of Pediatrics, Naval Medical Center, San Diego, California |
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| Abstract: | BackgroundIn 2014-2015, several regions of the United States experienced an outbreak of acute flaccid myelitis in pediatric patients. A common, unique feature was disease localization to the gray matter of the spinal cord.MethodsWe report 11 children, ages 13 months to 14 years (median 9 years), in the Intermountain West who presented with extremity weakness (n = 10) or cranial neuropathy (n = 1) of varying severity without an apparent etiology.ResultsAll children experienced acute paralysis, and 10 had symptoms or signs that localized to the spinal cord. Maximum paralysis occurred within 4 days of onset in all patients. All had spinal gray matter lesions consistent with acute myelitis detected by magnetic resonance imaging; no single infectious cause was identified. Despite therapy with intravenous immunoglobulin, corticosteroids, or plasma exchange, nine of 10 (90%) children had motor deficits at follow-up.ConclusionsRecognition of this disorder enables clinicians to obtain appropriate imaging and laboratory testing, initiate treatment, and provide families with accurate prognostic information. In contrast to other causes of acute flaccid paralysis in childhood, most children with acute flaccid myelitis have residual neurological deficits. |
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| Keywords: | myelitis flaccid paralysis enterovirus poliomyelitis Guillain-Barré syndrome |
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