Acute flaccid myelitis: A clinical review of US cases 2012–2015

Abstract

This review highlights clinical features of the increasing cases of acute flaccid paralysis associated with anterior myelitis noted in the United States from 2012 to 2015. Acute flaccid myelitis refers to acute flaccid limb weakness with spinal cord gray matter lesions on imaging or evidence of spinal cord motor neuron injury on electrodiagnostic testing. Although some individuals demonstrated improvement in motor weakness and functional deficits, most have residual weakness a year or more after onset. Epidemiological evidence and biological plausibility support an association between enterovirus D68 and the recent increase in acute flaccid myelitis cases in the United States.

Upsurge of Enterovirus D68, the Netherlands, 2016

“…MRI findings were subtle, and radiologic diagnosis was made only after further review and discussion of the case with the neurologists. The absence of EV-D68 in CSF is consistent with previous reports ( 1 , 12 ). …”

“…Evidence that EV-D68 might cause AFM is increasing after recent epidemiologic investigations ( 1 , 11 , 12 ). In patient 16, atypical Guillain-Barré syndrome initially was diagnosed; however, this diagnosis was later discarded because the electromyography results indicated motoric axon or anterior horn cell disease, and the clinical picture and MRI results were in favor of AFM ( 13 ).…”

Aumento inusual de casos de mielitis en un hospital pediátrico en Argentina

“…3 A partir de la erradicación de la poliomielitis, empezaron a tomar más relevancia otros enterovirus no polio que se asociaban a parálisis aguda fláccida y que podían provocar pequeños brotes. [1][2][3][4][5] Dentro de esta entidad, la mielitis es muy poco frecuente y puede ser secundaria tanto a causas infecciosas como no infecciosas, que deben ser evaluadas en forma minuciosa. Dentro de las causas infecciosas, se destacan las asociadas a los enterovirus (polio y no polio), arbovirus (dengue, zika, chikungunya, virus del Nilo Occidental), adenovirus y bacterias, como enfermedad de Lyme o rickettsiosis, entre otros.…”

“…y en Europa. 5,6 En EE. UU., en el año 2014, se documentaron 120 pacientes con mielitis confirmada, con una mediana de edad de 7 años y predominio de sexo masculino.…”

Clinical Reasoning: A man with rapidly ascending paralysis

“…In this syndrome, the clinical pathology and its radiographic correlate are largely restricted to the gray matter and anterior horn cells. 3 Bacterial infections, such as syphilis, Lyme disease, and Mycobacterium tuberculosis, can also be considered.…”