EMedHome's Clinical Pearl
Acute flaccid myelitis is a debilitating illness characterized by the sudden onset of flaccid limb weakness, with distinct gray matter lesions in the spinal cord on MRI. The cervical spine is most affected. This is not a new condition, but the large number of cases—542—reported since 2014 when the Centers for Disease Control and Prevention first started surveillance for this condition, is.
A viral-mediated pathogenesis for AFM has been suggested given similarities to poliovirus, associations with enterovirus D68, and seasonal variation. Most patients describe a mild respiratory illness or fever consistent with a viral infection in the one or two weeks before onset of weakness, which is rapid, within hours to a few days, and is often asymmetric.
Cranial nerve abnormalities may be present, and progression to respiratory failure is rapid. An MRI within the first 72 hours of limb weakness may be normal, and should be repeated if clinically indicated. CSF pleocytosis is typical. Complete recovery in acute flaccid myelitis is rare.
Not enough human evidence is available to indicate a preference for the three main treatments—IVIG, corticosteroids, and plasmapheresis. (Sources: Ann Emerg Med. Feb. 27, 2019, doi: 10.1016/j.annemergmed.2019.01.024; Centers for Disease Control and Prevention. Acute flaccid myelitis. May 6, 2019, http://bit.ly/2HaOFZH; JAMA Pediatr. 2019;173:117.)
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Amal Mattu, MD, and Colleagues: Pancreatitis and refusal of care: http://bit.ly/MattuEMN. Dr. Mattu is one of the premier speakers in emergency medicine, and a professor of emergency medicine and the vice chair of emergency medicine at the University of Maryland School of Medicine in Baltimore.
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Sean Bryant, MD: A Six Pack of Pearls from your Medical Toxicologist: http://bit.ly/EMN-EMedHomeVideos. Dr. Bryant is the assistant director of the toxicology fellowship program and an associate professor of emergency medicine at Cook County Health and Hospital System and Rush Medical College in Chicago.