Advertisement

Acute Flaccid Myelitis

  • Stephanie Morris
  • Young-Min Kim
  • Emmanuelle Waubant
  • Keith Van Haren
  • Soe S. Mar
Chapter

Abstract

Acute flaccid myelitis (AFM) is a polio-like syndrome characterized by acute inflammatory anterior horn cell disease. A widespread incidence of such cases in the United States in 2014 led to the coining of this new term. The features of AFM include a rapid onset of asymmetric extremity weakness with a proximal predominance that nadirs in 2–3 days, decreased or flaccid tone, and absent deep tendon reflexes in the affected extremities. Bulbar symptoms may occur, while mental status, sensation, and bladder and bowel function are typically preserved. A viral prodrome is typically associated. Prompt evaluation is critical for differentiating acute flaccid myelitis from other treatable causes of acute flaccid paralysis as proven treatments exist for other disorders. Supportive and neuro-rehabilitative therapy is central to the management of AFM; various immune-modulating treatments have been tried but have not shown to be effective. Long-term outcomes vary widely. A specific pathogen has not been identified in recent cases of AFM although several pathogens are known to cause a similar pattern of injury.

Keywords

Acute flaccid myelitis Acute flaccid paralysis Polio-like Poliomyelitis Anterior horn cell disease Motor neuronopathy Etiology Diagnosis Treatment Prognosis 

References

  1. 1.
    Ayscue P, Van Haren K, Sheriff H, et al. Acute flaccid paralysis with anterior myelitis—California, June 2012–June 2014. MMWR Morb Mortal Wkly Rep. 2014;63(40):903–6.PubMedGoogle Scholar
  2. 2.
    Sellner J, Luthi N, Schupbach WM, et al. Diagnostic workup of patients with acute transverse myelitis: spectrum of clinical presentation, neuroimaging, and laboratory findings. Spinal Cord. 2008;47:312–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Fokke C, Van Den Berg B, Drenthen J, et al. Diagnosis of Guillain-Barré syndrome and validation of brighton criteria. Brain. 2014;137(1):33–43.CrossRefPubMedGoogle Scholar
  4. 4.
    Cohen HA, Ashkenasi A, Ring H, et al. Poliomyelitis-like syndrome following asthma attack (Hopkins’ syndrome)—recovery associated with IV gamma globulin treatment. Infection. 1998;4:247–9.CrossRefGoogle Scholar
  5. 5.
    Pyrgos V, Younus F. High-dose steroids in the management of acute flaccid paralysis due to West Nile virus infection. Scan J Infect Dis. 2004;36(6–7):509–12.CrossRefGoogle Scholar
  6. 6.
    Acute flaccid myelitis: interim considerations for clinical management. Centers for Disease Control and Prevention Website. http://www.cdc.gov/ncird/investigation/viral/sep2014/hcp.html. Published November 7, 2014. Last Updated November 28, 2014. Accessed 5 Dec 2014.
  7. 7.
    Chang LY, Huang LM, Shur-Fen Gau S, et al. Neurodevelopment and cognition in children after enterovirus-71 infection. N Engl J Med. 2007;356:1226–34.CrossRefPubMedGoogle Scholar
  8. 8.
    Poliomyelitis. World Health Organization Website. http://www.who.int/ith/vaccines/polio/en/. Accessed 4 Mar 2015.

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Stephanie Morris
    • 1
  • Young-Min Kim
    • 2
  • Emmanuelle Waubant
    • 3
  • Keith Van Haren
    • 4
  • Soe S. Mar
    • 5
  1. 1.Department of NeurologyWashington University School of Medicine in St. LouisSt. LouisUSA
  2. 2.Department of PediatricsLoma Linda University School of MedicineSt. Loma LindaUSA
  3. 3.Clinical Neurology and Pediatrics, Regional Pediatric MS Clinic at UCSFUniversity of California San FranciscoSan FranciscoUSA
  4. 4.Department of NeurologyLucile Packard Children’s Hospital and Stanford University School of MedicinePalo AltoUSA
  5. 5.Department of NeurologyWashington University School of MedicineSt. LouisUSA

Personalised recommendations