Acute flaccid myelitis

Acute flaccid myelitis (AFM) is a serious condition of the spinal cord. Symptoms include rapid onset of arm or leg weakness and decreased reflexes. Difficulty moving the eyes, speaking, or swallowing may also occur. Occasionally numbness or pain may be present. Complications can include trouble breathing.Common features included acute focal limb weakness and specific findings on magnetic resonance imaging (MRI) of the spinal cord consisting of nonenhancing lesions largely restricted to the grey matter. In most cases, these lesions spanned more than one level of the spinal cord. Some also had acute cranial nerve dysfunction with correlating nonenhancing brainstem lesions on MRI. None of the children experienced altered mental status or seizures. None had any cortical, subcortical, basal ganglia, or thalamic lesions on MRI. Most children reported a febrile respiratory illness in the two weeks preceding development of neurologic symptoms. In most cases, cerebrospinal fluid (CSF) analyses demonstrated mild-moderate pleocytosis (increased cell count in the CSF) consistent with an inflammatory or infectious process.The three cases since August really look like each other. They have severe arm flaccidity and no mental status changes. All of them have similar spine MRIs showing gray matter involvement. You could lay all three MRIs on top of each other and they look almost the same. It's pretty striking. ... It you lift the arm up, it literally drops. Sensation is usually intact. There might be slightly decreased sensation in the other arm, but these are younger kids, so they're not always so cooperative in giving you a good sensory exam. Acute flaccid myelitis (AFM) is a serious condition of the spinal cord. Symptoms include rapid onset of arm or leg weakness and decreased reflexes. Difficulty moving the eyes, speaking, or swallowing may also occur. Occasionally numbness or pain may be present. Complications can include trouble breathing. The cause of most cases is unclear as of 2018. More than 90% of recent cases have followed a mild viral infection such as from enteroviruses. While polio can cause AFM, since 2014 it has not been involved in cases in the United States. The underlying mechanism involves damage to the spinal cord's grey matter. Diagnosis may be supported by medical imaging of the spine, nerve conduction studies, and cerebral spinal fluid testing. Prevention includes polio vaccination and avoiding mosquitoes bites. Treatment involves supportive care. Physical therapy may be recommended. Occasionally mechanical ventilation is required to support breathing. Outcomes are variable. The condition is rare and occurs most commonly in children. Less than 2 per million children are affected per year in the United States. Although the illness is not new, an increase in cases has been seen since 2014 in the United States. In 2018 there were 233 confirmed cases in the United States.