Acute flaccid myelitis

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

https://wwwn.cdc.gov/nndss/conditions/acute-flaccid-myelitis/case-definition/2018/

References