Ver el código de «Acute flaccid myelitis»

==Background==
*[[Polio]]-like illness, subset of [[transverse myelitis]]
*More common in children
*Likely caused by:
**[[Enterovirus]], particularly [[Enterovirus D68]], [[poliovirus]]
**[[West nile virus]]
**[[Adenovirus]]

==Clinical Features<ref>http://www.cdc.gov/acute-flaccid-myelitis/</ref>==
*Acute onset, focal [[weakness]] of 1 or more extremity
*Decreased muscular tone
*Absent or hypoactive [[reflexes]]
*Rarely have [[numbness]], but may have some [[neuropathic pain]]
*[[Fever]] and other symptoms of infection by causative virus (e.g. [[URI]] symptoms, [[gastroenteritis]])
*In severe cases:
**Bulbar dysfunction ([[dysphagia]], [[dysarthria]], [[dysphonia]], [[facial weakness]], ptosis)
**[[respiratory failure|Respiratory muscle weakness]]
**Autonomic instability, [[arrhythmias]] if cervical lesion present
*Paralysis usually maximal at 3-5 days after onset

==Differential Diagnosis==
{{Weakness DDX}}

==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]])
*[[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
**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>==
*Report suspected cases to CDC/department of health
*Respiratory:
**Consider [[intubation]] for airway protection if evidence of bulbar dysfunction
**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]]
*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==
*[[Weakness]]
*[[Enterovirus D68]]
*[[Transverse myelitis]]

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

==References==
<references/>

[[Category:Neurology]] [[Category:Pediatrics]]