Acute flaccid myelitis - Revision history

Rossdonaldson1: /* External Links */

2020-10-24T09:16:48Z

External Links

← Older revision		Revision as of 09:16, 24 October 2020
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	==External Links==		==External Links==
			*https://wwwn.cdc.gov/nndss/conditions/acute-flaccid-myelitis/case-definition/2018/
	https://wwwn.cdc.gov/nndss/conditions/acute-flaccid-myelitis/case-definition/2018/

	==References==		==References==

ClaireLewis at 21:48, 1 October 2019

2019-10-01T21:48:14Z

← Older revision		Revision as of 21:48, 1 October 2019
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	==Background==		==Background==
	*Polio-like illness, subset of [[transverse myelitis]]		*[[Polio]]-like illness, subset of [[transverse myelitis]]
	*More common in children		*More common in children
	*Likely caused by:		*Likely caused by:
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	*Acute onset, focal [[weakness]] of 1 or more extremity		*Acute onset, focal [[weakness]] of 1 or more extremity
	*Decreased muscular tone		*Decreased muscular tone
	*Absent or hypoactive reflexes		*Absent or hypoactive [[reflexes]]
	*Rarely have numbness, but may have some neuropathic pain		*Rarely have [[numbness]], but may have some [[neuropathic pain]]
	*[[Fever]] and other symptoms of infection by causative virus (e.g. [[URI]] symptoms, [[gastroenteritis]])		*[[Fever]] and other symptoms of infection by causative virus (e.g. [[URI]] symptoms, [[gastroenteritis]])
	*In severe cases:		*In severe cases:
	**Bulbar dysfunction (dysphagia, dysarthria, dysphonia, facial weakness, ptosis)		**Bulbar dysfunction ([[dysphagia]], [[dysarthria]], [[dysphonia]], [[facial weakness]], ptosis)
	**Respiratory muscle weakness		**[[respiratory failure\|Respiratory muscle weakness]]
	**Autonomic instability, ~~arrythmias~~ if cervical lesion present		**Autonomic instability, [[arrhythmias]] if cervical lesion present
	*Paralysis usually maximal at 3-5 days after onset		*Paralysis usually maximal at 3-5 days after onset

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	[[File:MRI Brain and Spinal Cord in a child with Acute Flaccid Myelitis.png\|thumb\| <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234096/</ref>]]		[[File:MRI Brain and Spinal Cord in a child with Acute Flaccid Myelitis.png\|thumb\| <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234096/</ref>]]
	*Evaluate for other causes of symptoms (e.g. [[HSV]], [[bacterial meningitis]], [[Guillain-Barre syndrome]])		*Evaluate for other causes of symptoms (e.g. [[HSV]], [[bacterial meningitis]], [[Guillain-Barre syndrome]])
	*CSF: Pleocytosis (WBC count >5 cells/mm<sup>3</sup>), +/- elevated protein		*[[LP\|CSF]]: Pleocytosis (WBC count >5 cells/mm<sup>3</sup>), +/- elevated protein
	*MRI: spinal cord lesion, largely restricted to gray matter, spanning one or more spinal segments		*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.		**Spinal cord lesions may not be present on initial MRI if performed within the first 72 hours of onset of acute limb weakness.
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	*Report suspected cases to CDC/department of health		*Report suspected cases to CDC/department of health
	*Respiratory:		*Respiratory:
	**Consider intubation for airway protection if evidence of bulbar dysfunction		**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)		**Consider [[biPAP\|NIPPV]] if evidence of respiratory muscle weakness (by clinical exam, hypoxia, hypercarbia, vital capacity <15 mL/kg, or NIF <30)
	*Treat neuropathic pain		*Treat [[neuropathic pain]]
	*Elevate head of bed >30 degrees		*Elevate head of bed >30 degrees
	*No evidence of benefit from [[corticosteroids]], [[IVIG]], plasmapheresis, or antivirals as of yet		*No evidence of benefit from [[corticosteroids]], [[IVIG]], plasmapheresis, or antivirals as of yet

Rossdonaldson1: /* Evaluation */

2019-05-17T05:10:46Z

Evaluation

← Older revision		Revision as of 05:10, 17 May 2019
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	*CSF: Pleocytosis (WBC count >5 cells/mm<sup>3</sup>), +/- elevated protein		*CSF: Pleocytosis (WBC count >5 cells/mm<sup>3</sup>), +/- elevated protein
	*MRI: spinal cord lesion, largely restricted to gray matter, spanning one or more spinal segments		*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.)		**Spinal cord lesions may not be present on initial MRI if performed within the first 72 hours of onset of acute limb weakness.

	==Management<ref>http://www.cdc.gov/acute-flaccid-myelitis/downloads/acute-flaccid-myelitis.pdf</ref>==		==Management<ref>http://www.cdc.gov/acute-flaccid-myelitis/downloads/acute-flaccid-myelitis.pdf</ref>==

Rossdonaldson1: /* Evaluation */

2019-05-17T05:09:33Z

Evaluation

← Older revision		Revision as of 05:09, 17 May 2019
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	*CSF: Pleocytosis (WBC count >5 cells/mm<sup>3</sup>), +/- elevated protein		*CSF: Pleocytosis (WBC count >5 cells/mm<sup>3</sup>), +/- elevated protein
	*MRI: spinal cord lesion, largely restricted to gray matter, spanning one or more spinal segments		*MRI: spinal cord lesion, largely restricted to gray matter, spanning one or more spinal segments
	~~<small>~~(Spinal cord lesions may not be present on initial MRI if performed within the first 72 hours of onset of acute limb weakness.)~~</small>~~		**(Spinal cord lesions may not be present on initial MRI if performed within the first 72 hours of onset of acute limb weakness.)

	==Management<ref>http://www.cdc.gov/acute-flaccid-myelitis/downloads/acute-flaccid-myelitis.pdf</ref>==		==Management<ref>http://www.cdc.gov/acute-flaccid-myelitis/downloads/acute-flaccid-myelitis.pdf</ref>==

Rossdonaldson1 at 05:08, 17 May 2019

2019-05-17T05:08:21Z

← Older revision		Revision as of 05:08, 17 May 2019
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	==Evaluation==		==Evaluation==
			[[File:MRI Brain and Spinal Cord in a child with Acute Flaccid Myelitis.png\|thumb\| <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234096/</ref>]]
	*Evaluate for other causes of symptoms (e.g. [[HSV]], [[bacterial meningitis]], [[Guillain-Barre syndrome]])		*Evaluate for other causes of symptoms (e.g. [[HSV]], [[bacterial meningitis]], [[Guillain-Barre syndrome]])
	*CSF: Pleocytosis (WBC count >5 cells/mm<sup>3</sup>), +/- elevated protein		*CSF: Pleocytosis (WBC count >5 cells/mm<sup>3</sup>), +/- elevated protein
	*MRI: spinal cord lesion, largely restricted to gray matter, spanning one or more spinal segments		*MRI: spinal cord lesion, largely restricted to gray matter, spanning one or more spinal segments
	<small>(Spinal cord lesions may not be present on initial MRI if performed within the first 72 hours of onset of acute limb weakness.)</small>		<small>(Spinal cord lesions may not be present on initial MRI if performed within the first 72 hours of onset of acute limb weakness.)</small>

	~~[[File:MRI Brain and Spinal Cord in a child with Acute Flaccid Myelitis.png\|thumb\| <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234096/</ref>]]~~

	==Management<ref>http://www.cdc.gov/acute-flaccid-myelitis/downloads/acute-flaccid-myelitis.pdf</ref>==		==Management<ref>http://www.cdc.gov/acute-flaccid-myelitis/downloads/acute-flaccid-myelitis.pdf</ref>==

Rossdonaldson1: /* Evaluation */

2019-05-17T05:07:53Z

Evaluation

← Older revision		Revision as of 05:07, 17 May 2019
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	<small>(Spinal cord lesions may not be present on initial MRI if performed within the first 72 hours of onset of acute limb weakness.)</small>		<small>(Spinal cord lesions may not be present on initial MRI if performed within the first 72 hours of onset of acute limb weakness.)</small>

	[[File:MRI Brain and Spinal Cord in a child with Acute Flaccid Myelitis.png\|thumb <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234096/</ref>]]		[[File:MRI Brain and Spinal Cord in a child with Acute Flaccid Myelitis.png\|thumb\| <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234096/</ref>]]

	==Management<ref>http://www.cdc.gov/acute-flaccid-myelitis/downloads/acute-flaccid-myelitis.pdf</ref>==		==Management<ref>http://www.cdc.gov/acute-flaccid-myelitis/downloads/acute-flaccid-myelitis.pdf</ref>==

Anm464: /* Evaluation */

2019-05-02T18:14:10Z

Evaluation

← Older revision		Revision as of 18:14, 2 May 2019
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	*MRI: spinal cord lesion, largely restricted to gray matter, spanning one or more spinal segments		*MRI: spinal cord lesion, largely restricted to gray matter, spanning one or more spinal segments
	<small>(Spinal cord lesions may not be present on initial MRI if performed within the first 72 hours of onset of acute limb weakness.)</small>		<small>(Spinal cord lesions may not be present on initial MRI if performed within the first 72 hours of onset of acute limb weakness.)</small>

			[[File:MRI Brain and Spinal Cord in a child with Acute Flaccid Myelitis.png\|thumb <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234096/</ref>]]

	==Management<ref>http://www.cdc.gov/acute-flaccid-myelitis/downloads/acute-flaccid-myelitis.pdf</ref>==		==Management<ref>http://www.cdc.gov/acute-flaccid-myelitis/downloads/acute-flaccid-myelitis.pdf</ref>==

Anm464: /* Differential Diagnosis */

2019-05-02T18:13:22Z

Differential Diagnosis

← Older revision		Revision as of 18:13, 2 May 2019
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Weakness DDX}}		{{Weakness DDX}}

	~~[[File:MRI Brain and Spinal Cord in a child with Acute Flaccid Myelitis.png\|thumb <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234096/</ref>]]~~

	==Evaluation==		==Evaluation==

Anm464: /* Evaluation */

2019-05-02T18:11:57Z

Evaluation

← Older revision		Revision as of 18:11, 2 May 2019
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Weakness DDX}}		{{Weakness DDX}}

			[[File:MRI Brain and Spinal Cord in a child with Acute Flaccid Myelitis.png\|thumb <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234096/</ref>]]

	==Evaluation==		==Evaluation==

Anm464: /* External Links */

2019-05-02T17:56:42Z

External Links

← Older revision		Revision as of 17:56, 2 May 2019
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	==External Links==		==External Links==

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

	==References==		==References==