A form for immediate notification of acute flaccid paralysis, form 1 37 a case investigation form for acute flaccid paralysis, form 2 28 a laboratory request reporting form for submission of stool specimen, form 3 40 a form for 60day followup examination of afp case, form 4 41 a form for final classification of afp case, form 5 41. Acute flaccid paralysis in infants and young children with. In a patient with holmesadie syndrome, and in another with tabes dorsalis, a transverse cord lesion resulted in a severe, but flaccid paraplegia with absent tendon reflexes. Acute west nile infection and campylobacter have also been associated with afp. The rise stimulator was designed specifically for this condition. A weekly reporting form, including acute flaccid paralysis, form 9 45 a monthly reporting forms, including acute flaccid paralysis and polio cases, form 10 46 a weekly active surveillance form, form 11 47 a form to monitor completeness and timeliness. With a severe deformity, interpretation of these images can be confusing, however, and often inconclusive. It may result from many causes, of which the most common are. Rehabilitation for paraplegia caused by neuromyelitis optica. Rehabilitation for paraplegia caused by neuromyelitis.
Flaccid paraplegia is a flaccid paralysis of two corresponding extremities, and is the antithesis of spastic paraplegia. Acute aortic occlusion presenting as flaccid paraplegia. Whether the locations of paralysis are related to the primary site of infection respiratory versus gastrointestinal remains unknown. Pdf approach to a child with acute flaccid paralysis. The comment by paul francis april 21, p 221 is based on a misunderstanding of poliomyelitis surveillance methods, and particularly the definition of poliomyelitiscompatible cases. If paraplegia is present, mri or ct with myelography is appropriate to find the cause of paraplegia.
Flaccid paraplegia from compression of the cord brain. Francis assumes that compatible cases are true cases and uses them to inflate the number of polio cases in india. Mri findings in children with acute flaccid paralysis and. Speedy reach to hospital at the earliest warning signs is a must.
During 2014, we dealt with eleven cases of acute nontraumatic paraplegia, in our. The clinical profile, possible pathogenesis, and treatment of hopkins syndrome are discussed. The term flaccid indicates the absence of spasticity or other signs of disordered central nervous system motor tracts such as hyperreflexia, clonus, or extensor plantar. Neurophysiologic studies demonstrated spinal cord injury at the level of t7 and below in patient 1 and at the level of l1 and below in patient 2. Complete flaccid paralysis following spinal anaesthesia a case report. Surveillance of acute flaccid paralysis in india the lancet. Acute flaccid paralysis afp is a clinical syndrome characterized by rapid onset of weakness due to various conditions and the term flaccid indicates lack of corticospinal tract signs on. Author links open overlay panel gentian vyshka a altin kuqo b serla grabova b eris ranxha b liro buda b. Can affect reflexes, automatic, or voluntary movements. Afm is characterized by acute flaccid paralysis with focal or asymmetric limb weakness and characteristic spinal gray matter lesions on imaging.
Deferred spinal cord magnetic resonance imaging confirmed regional spinal cord atrophy. Flaccid paralysis of the dorsiflexors, in the absence of any significant increase in plantarflexor tone, results in a dropfoot that is a problem principally in swing phase on stairs and inclines or when navigating over obstacles. Here we present a case of gbs presenting with flaccid paralysis as well as hyponatremia. It is defined as a sudden onset of paralysis or weakness in any part of the body of a child less than 15 years of age. Acute flaccid paralysis in infants and young children with enterovirus 71 infection.
The purpose of this report is to describe the unique imaging findings of this neurologic syndrome. Paraplegia spastic flaccid paraplegia in extension paraplegia in flexion 4. By continuing to use our website, you are agreeing to our use of cookies. According to the criteria of asia impairment scale, flaccid paraplegia below t5, muscle weakness of lower limbs manual muscle test score of 0, hypoesthesia from t5 to t6 and anesthesia below t7. The differential diagnosis of flaccid paralysis ncbi. Pdf complete flaccid paralysis following spinal anaesthesia. Improvement of the muscle capillary supply after earlystarted daily functional electric stimulation fes in human permanent lower motoneuron denervation roberto scelsi, paola poggi 1, ugo carraro 2, helmut kern 3 department of human. Epidemiological alert acute flaccid myelitis associated with enterovirus d68 in the context of acute flaccid paralysis surveillance 1 november 2017. There is no treatment for polio, but many people are vaccinated. This child presented with sudden onset bilateral lower extremity weakness, normal tone, hyporeflexia, and bladderbowel involvement. Ophthalmoplegia and flaccid paraplegia in a patient with anti. That year, the nonpolio acute flaccid paralysis npafp rate in india was. Ophthalmoplegia and flaccid paraplegia in a patient with. Afp surveillance was first used in the region of the americas during the 1980s.
Acute flaccid paralysis implies paralysis of acute onset i. It occurs in lower motor neuron diseases occurs due to loss of stimulatory innervation to muscle decreased muscle tone atrophied muscle absent deep tendon reflexes flexor or equivocal plantar with or without fasciculations. Our object is to report two cases of flaccid paraplegia of rather unusual origin. Loss or impairment of motor function in a part due to a lesion of the neural or muscular mechanism. Pain arising from the spinal site of metastasis is usually l5s1 arachnoiditis figure 10. Gbs is the most common cause of acute flaccid paralysis in healthy infants and children. Differential diagnosis of acute flaccid paralysis and its. Spinal unit, armed forces institute of rehabilitation. She developed disorientation and hallucination after fever and vomiting.
Journal of acute disease 201516 1 contents lists available at sciencedirect journal of acute disease journal homepage. Flaccid paralysis is a neurological condition characterized by weakness or paralysis and reduced muscle tone without other obvious cause e. Flaccid paralysis of the limbs after an asthmatic attack. The association of hyponatremia in gbs is discussed, as well as other potential causes and risk factors. Massage management of flaccid paralysis facial palsy. Flaccid paraplegia due to anterior spinal artery thrombosis has. There were 2 weeks of nonspecific, intermittent back pain, but she had been previously well.
Acute flaccid paralysis afp is a lower motor neuron lesion. Botulism is a rare, severe, and potentially lethal condition caused by the botulinum toxin. A rare complication of meningococcal meningitis article pdf available in spinal cord 464. Earl2 fromthe departmentofneurology, section ofneurologicalsciences, thelondonhospital, london synopsis in a patient with holmesadie syndrome, andin another withtabes dorsalis, a trans.
During this time, several patients presented to our institution with acute flaccid paralysis and cranial nerve dysfunction. Acute flaccid myelitis afm is a condition that affects the nervous system, specifically the spinal cord. The patients have been reported from central texas and the dallasfort worth metroplex areas. It is characterized by symmetric cranial nerve palsy, commonly followed by symmetric, descending, flaccid paralysis of involuntary muscles, which may result in respiratory compromise and death. She was a lifelong nonsmoker and did not drink alcohol. Besides poliomyelitis, an array of viruses may be causative. Jul, 2004 eb, a 43yearold woman, suffered from flaccid paraplegia with areflexia of lower extremities, anaesthesia from d12l1 and stress urinary incontinence owing to an intraoperative complication. To describe a rare complication of meningococcal meningitis.
Mr imaging findings and clinical correlates chengyu chen, yingchao chang, chaoching huang, chunchung lui, kwowei lee, and songchei huang background and purpose. Mufioz, md, carmen roche, md, rosa escribfi, md, antonio martinezbermejo, md, and ignacio pascualcastroviejo, phd two patients are described who acquired neonatal flaccid paraplegia associated with umbilical artery catheterization. Guillainbarre syndrome gbs is the most common cause of flaccid paralysis in affected patients. Traumatic injection neuritis tin is an iatrogenic condition caused by unsafe intramuscular gluteal injection practices leading to different forms of clinical manifestations ranging from mild. Has to do with issues related to the neuromuscular junction. The significance of these observations is discussed in relation to the functional and anatomical disorder in these two syndromes. Differential diagnosis of flaccid paralysis in paediatric medicine. Differential diagnosis of acute flaccid paralysis and its role in poliomyelitis surveillance, epidemiologic r we use cookies to enhance your experience on our website.
Flexor spasms were severe in both patients, but spasticity was absent. Secondly, enterovirus d68associated afm most commonly causes flaccid paralysis in the upper extremities, while the poliovirus most commonly causes flaccid paralysis in the lower extremities. The patient also had scoliosis, cleft palate, hearing impairment, excessive sweating. A previous study of data from 2000 to 2010 has detailed the. Acute exacerbations of asthma are common in children, but limb weakness after such exacerbations is very unusual. He was trained in clean intermittent catheterization for bladder. We read with great interest the study by saltzman et al. Acute flaccid paralysis afp is a clinical syndrome characterized by rapid onset of weakness due to various conditions and the term flaccid indicates lack of corticospinal tract signs on examination spasticity, hyperreflexia, and extensor. We describe a child with weakness of the lower limbs after an asthmatic attack. Flaccid paralysis an overview sciencedirect topics. The main requirement is that the user cant feel a thing in his or her paralyzed muscles. Patients presenting with paraplegia resulting from metastatic tumours typically have a history of localised back pain in combination with a mainly flaccid type paraplegia developing over a short period, usually days or weeks. With virtual elimination of poliomyelitis, gbs has become the most common cause of acute flaccid paralysis in many parts of the world. Acute flaccid paralysis afp surveillance is one of the main strategies for eradicating polio.
Flaccid paraplegia as complication of umbilical artery. Rapidonset flaccid paraplegia caused by multiple myeloma. We herein report the case of a 26yearold woman with antinmethyldaspartate receptor nmdar encephalitis presenting with ophthalmoplegia and flaccid paraplegia. Afm is thought to be caused by infections with different types of viruses. Osborne c, stallworthy s, evanson j, sylvester r, noyce aj pract neurol 2014 aug. A weekly reporting form, including acute flaccid paralysis, form 9 45 a monthly reporting forms, including acute flaccid paralysis and polio cases, form 10 46 a weekly active surveillance form, form 11 47 a form to monitor completeness and timeliness of weekly reports received, form 12 49 6 tables 50. Pdf acute flaccid paraplegia is a clinical occurrence with extreme importance, due to the dramatic presentation, the. In a series from new york ungarsargon et al 1980 only 16 patients out of 672 admitted with a diagnosis of spastic paraplegia were recognized as having a familial disorder, although a few further cases may have had a genetic disorder and by chance have been isolated. Surveillance for acute flaccid myelitis o in 2014, cdc detected an unusual increase in reports of acute flaccid myelitis afm nationwide, and sporadic reports continue to be received. According to the criteria of asia impairment scale, flaccid paraplegia below t5, muscle weakness of lower limbs manual muscle test score of 0, hypoesthesia from t5 to. Hypothermia, hypoventilation, hypertension, paralytic ileus and hyponatremia were present. Scribd is the worlds largest social reading and publishing site. A case of arnoldchiari syndrome with flaccid paralysis and.
Sarah bundey mb, frcp, in genetics and neurology, 1985. He further suggests that standard surveillance methods and interpretation of. Permanent flaccid paraplegia in children with thoracic. Sep 11, 2007 a case report of spinal cord dysfunction following meningococcal meningitis. Flaccid paralysis definition of flaccid paralysis by. Acute compressive myelopathy was excluded by mri of the dorsal and lumbar spines. These include nonpolio enteroviruses enterovirus d68 and a71.
The nerve conduction study and csf analysis was suggestive of acute demyelinating polyneuropathy. It was caused by interruption in the blood supply to my brain. The functional flaccid paraplegia of hysteria naturally lacks those components of the flaccid paraplegic syndrome which are the result of a lesion of the lower motor neuron. From the beginning of the initiative, the key strategy to detect transmission of poliovirus and monitor the impact of eradication activities has been surveillance for children flaccid paralysis afp, the lead symptom of paralytic poliomyelitis 3. Improvement of the muscle capillary supply after earlystarted daily functional electric stimulation fes in human permanent lower motoneuron denervation roberto scelsi, paola poggi 1, ugo carraro 2, helmut kern 3 department of human pathology and 1 human anatomy, university of pavia. Rapidonset flaccid paraplegia caused by multiple myeloma dumbbell tumour. However, with the present day almost universal use of the parenteral method of introducing therapeutic and prophylactic agents, an increasing number of paralytic accidents is being reported. The reflexes are normal or even exaggerated, but this increase is only that which is noted in many highly nervous individuals and its exists also in the. The overall prognosis of gbs is quite good, children with vital capacity approximately one half the normal value for age or. This abnormal condition may be caused by disease or by trauma affecting the nerves associated with the involved muscles. The last case of polio from india was reported in 2011. Acute flaccid paraplegia is a clinical occurrence with extreme importance, due to the dramatic presentation, the severity of the underlying disorder, and the. There are many causes of afp including infectious, autoimmune, and acquired causes. Acute flaccid myelitis afm came to national attention in 2014 after reports from colorado and california of an increase in children presenting with acute onset of flaccid paralysis with mri findings of grey matter lesions of the spinal cord.
Acute flaccid paraplegia free download as powerpoint presentation. Pdf acute aortic occlusion presenting as flaccid paraplegia. The term flaccid indicates the absence of spasticity or other signs of disordered central nervous system motor tracts such as hyperreflexia, clonus, or extensor plantar responses. Apr 27, 2004 we treated a rare case of arnoldchiari syndrome, which showed flaccid paralysis in the lower extremities. Enterovirus d68 was responsible for widespread outbreaks of respiratory illness throughout the united states in august and september 2014. Two patients are described who acquired neonatal flaccid paraplegia associated with umbilical artery catheterization. For example, if the somatic nerves to a skeletal muscle are severed, then the muscle will exhibit flaccid paralysis. Download fulltext pdf download fulltext pdf acute aortic occlusion presenting as flaccid paraplegia article pdf available april 2015 with 45 reads. Download fulltext pdf download fulltext pdf acute flaccid paraplegia. This leads to difficulty clearing the ground with the affected leg, with adoption of compensatory strategies such as. Acute flaccid paraplegia is a clinical occurrence of extreme importance, due to the dramatic presentation, the severity of the underlying disorder, and the generally poor prognosis that follows such a condition. Call for cases of acute flaccid myelitis july 6, 2016 in may and june 2016, the department of state health services dshs received reports of seven children suspected of having acute flaccid myelitis afm. A 43yearold female ghanaian office cleaner presented to the emergency department with a 2day history of progressive, ascending lower limb weakness, with sensory disturbance and urinary retention. Acute flaccid myelitis patient summary form author.
Acute flaccid paralysis afp is a clinical syndrome characterized by rapid onset of weakness of lower motor neuron type, including weakness of the respiratory and pharyngeal muscles, progressing to maximum severity within several days to weeks. Differential diagnosis of acute flaccid paralysis and its role in poliomyelitis surveillance, epidemiologic r. Neurologic complications following the administration of serums and vaccines are fortunately uncommon. Flaccid paraplegia as complication of umbilical artery catheterization maria e. Afp is a complex clinical syndrome with a broad array of potential etiologies that vary remarkably. Causes of acute flaccid paralysis afp worldwide acute flaccid. A 67yearold male known to be hypertensive and diabetic had a sudden onset of severe low back pain and flaccid paraplegia with no sensory level or bladder affection and the distal pulsations were felt.
Hopkins syndrome, a poliomyelitislike illness associated with asthma, is seldom reported in the literature. Paraplegia is impairment in motor and or sensory functions of the lower extremities often including lower part of the trunk. Most patients have sudden onset of limb arm and leg weakness. Acute flaccid paralysis afp may be caused by a number of agents including enterovirus, echovirus or adenovirus. Describe how fcplmn deals with flaccid dysarthria and what may be affected. Tone is decreased as observed by palpation or passive movements of joints. Flaccid paralysis can be treated using medicine, like antibiotics, if the cause is a bacterial infection. Severe or complete loss of motor function in all four limbs which may result from brain diseases. Correlation between nonpolio acute flaccid paralysis. Among 12 children with complete thoracic spinal cord injury four developed permanent flaccid paraplegia with areflexia and an autonomous bladder. A bowel routine was established with highfiber diet and manual evacuations. Traumatic injection neuritis and acute flaccid paralysis. Definitions of flaccid quadriplegia, synonyms, antonyms, derivatives of flaccid quadriplegia, analogical dictionary of flaccid quadriplegia english.