Acute flaccid myelitis

Acute flaccid myelitis
Other namesAcute flaccid paralysis with anterior myelitis, polio-like syndrome[1]
Magnetic resonance imaging of the spinal cord in a case of AFM showing cord swelling in (d) which has resolved three weeks later in (e).[2]
SpecialtyNeurology[3]
SymptomsWeakness, decreased reflexes, trouble swallowing or speaking[3]
ComplicationsTrouble breathing, urinary retention[3]
Usual onsetRapid[3]
CausesGenerally unknown; thought to be caused by viral infection[4]
Diagnostic methodMedical imaging, nerve conduction studies, cerebral spinal fluid testing[3][5]
Differential diagnosisTransverse myelitis, Guillain–Barré syndrome, acute disseminated encephalomyelitis[3][5]
TreatmentSupportive care, physical therapy, mechanical ventilation[3][5]
PrognosisVariable[5]
FrequencyRare[4]

Acute flaccid myelitis (AFM) is a serious condition of the spinal cord.[3][5] Symptoms include rapid onset of arm or leg weakness and decreased reflexes.[3] Difficulty moving the eyes, speaking, or swallowing may also occur.[3] Occasionally, numbness or pain may be present.[3] Complications can include trouble breathing.[3]

The cause of most cases is unclear as of 2018.[4] More than 90% of recent cases have followed a mild viral infection such as from enteroviruses.[4] While polio can cause AFM, since 2014, it has not been involved in cases in the United States.[3][6] The underlying mechanism involves damage to the spinal cord's grey matter.[3] Diagnosis may be supported by medical imaging of the spine, nerve conduction studies, and cerebrospinal fluid testing.[3][5]

Treatment involves supportive care.[5][3] Physical therapy may be recommended.[3] Occasionally, mechanical ventilation is required to support breathing.[3] Outcomes are variable.[5] The condition is rare and occurs most commonly in children.[4] Fewer than one in 500,000 children is affected per year in the United States.[3] Although the illness is not new, an increase in cases has been seen since 2014 in the United States.[3] In 2018, 233 cases were confirmed in the United States.[7]

  1. ^ "Acute Flaccid Myelitis" (PDF). www.dhs.wisconsin.gov. January 2017. Archived (PDF) from the original on 1 May 2018. Retrieved 22 December 2018.
  2. ^ Esposito S, Chidini G, Cinnante C, Napolitano L, Giannini A, Terranova L, Niesters H, Principi N, Calderini E (January 2017). "Acute flaccid myelitis associated with enterovirus-D68 infection in an otherwise healthy child". Virol J. 14 (1): 4. doi:10.1186/s12985-016-0678-0. PMC 5234096. PMID 28081720.
  3. ^ a b c d e f g h i j k l m n o p q r s t "About Acute Flaccid Myelitis". Centers for Disease Control and Prevention (CDC). Archived from the original on 2018-10-11. Retrieved 2018-10-11.Public Domain This article incorporates text from this source, which is in the public domain.
  4. ^ a b c d e "Acute Flaccid Myelitis". Centers for Disease Control and Prevention (CDC). 17 December 2018. Archived from the original on 21 December 2018. Retrieved 21 December 2018.{{cite web}}: CS1 maint: unfit URL (link)Public Domain This article incorporates text from this source, which is in the public domain.
  5. ^ a b c d e f g h "Acute flaccid myelitis". rarediseases.info.nih.gov. 2018. Archived from the original on 22 December 2018. Retrieved 22 December 2018.
  6. ^ Bitnun A, Yeh EA (June 2018). "Acute Flaccid Paralysis and Enteroviral Infections". Curr Infect Dis Rep. 20 (9): 34. doi:10.1007/s11908-018-0641-x. PMID 29959591. S2CID 49619082.
  7. ^ Lopez A, Lee A, Guo A, Konopka-Anstadt JL, Nisler A, Rogers SL, et al. (July 9, 2019). "Vital Signs: Surveillance for Acute Flaccid Myelitis — United States, 2018" (PDF). MMWR Morb Mortal Wkly Rep. 68 (27): 608–14. doi:10.15585/mmwr.mm6827e1. PMID 31295232. S2CID 195892448. Archived (PDF) from the original on July 13, 2019. Retrieved July 13, 2019. During 2018, 233 confirmed AFM cases were reported, the largest number since surveillance began in 2014. Upper limb involvement only was more prevalent in confirmed cases (42%), as was report of respiratory symptoms or fever (92%) within four weeks preceding limb weakness onset. Median intervals from onset of limb weakness to hospitalization, magnetic resonance imaging, and reporting to CDC were 1, 2, and 18 days, respectivelyPublic Domain This article incorporates text from this source, which is in the public domain.