Pediatric acute flaccid myelitis: Evaluation of diagnostic criteria and differentiation from other causes of acute flaccid paralysis

Enterovirus A71-associated acute flaccid paralysis in a pediatric patient: a case report

“…However, the authors noted that MRT abnormalities could be subtle early in the disease and even be interpreted as normal in the clinical setting [ 21 ]. Helfferich et al also described a case of EV-D68-associated AFM in a child that did not show MRT abnormalities even upon repeated scans [ 22 ]. In our case, the patient had acute flaccid paralysis of her left arm that was not accompanied by any abnormalities in the MRT of the skull or cervical vertebra or in the nerve conduction studies.…”

Acute flaccid myelitis in low- to middle-income countries: diagnosis and surveillance

“…The second is also important for high-income countries, as abnormalities may be very difficult to detect, which might lead to incorrect rejection of the diagnosis. 3 We do, however, believe that, when available, detection of grey matter abnormalities on MRI is important for confirming the diagnosis of AFM and maybe even more so for excluding alternative causes of AFP in clinical practice, similar to the situation for other inflammatory myelopathies. 7 …”

“…In children presenting with acute flaccid paralysis (AFP), it may be difficult to make an aetiological diagnosis at onset, even if all investigations, including imaging and virological tests, are available. 2 , 3 Contrary to poliomyelitis, where the diagnosis can be confirmed by finding poliovirus in a faecal sample of a patient with AFP, the diagnosis of AFM depends on clinical and diagnostic characteristics, as different viruses other than poliovirus may be associated. 4 Early clinical features that may help to differentiate AFM from other causes of AFP in children have been identified ( Table 1 ).…”

“… 4 Early clinical features that may help to differentiate AFM from other causes of AFP in children have been identified ( Table 1 ). 2 , 3 , 5 These include the presence of a sensory level, described in one of the cases by Olum et al ., which would, in our opinion, exclude the diagnosis of AFM. 1 AFM is mainly an anterior horn disease, while a sensory level indicates more diffuse spinal cord involvement, which may be present in other forms of paediatric myelopathies such as neuromyelitis optica and myelin oligodendroglial glycoprotein (MOG) antibody-associated disease or acute vascular injury of the spinal cord.…”