Conflict of interest statement references the authors report no conflict of interest. The differential diagnosis for afp includes a number of other conditions such as guillainbarre syndrome, transverse myelitis and other infections e. Flaccid asymmetric weakness and muscle atrophy are the hallmarks of its clinical manifestations, due to loss of motor neurons and denervation of. Acute flaccid paralysis associated with novel enterovirus. Pdf differential diagnosis of acute flaccid paralysis. Loss or impairment of motor function in a part due to a lesion of the neural or muscular mechanism. Pdf pacute flaccid paralysis afp is a common presentation to the emergency department and. An afp case is any child under 15 years of age with acute onset of floppy paralysis, or a person of any age in whom poliomyelitis is suspected by a physician. Pdf approach to a child with acute flaccid paralysis. Acute flaccid paralysis afp is a clinical syndrome characterized by a sudden onset of weakness of a limb, described as flaccid in a child below 15 years of age afp mimics the clinical presentation of poliomyelitis, hence afp surveillance was adopted globally as a key strategy for monitoring the. It is a rare condition with fewer than a million new patients recorded worldwide. Less than 2% of all polio infections result in a flaccid paralysis. The term acute flaccid paralysis afp is often used to describe a instance with a sudden onset, as might be found with polio afp is the most common sign of acute polio, and used for surveillance during polio outbreaks. Afp is also associated with a number of other pathogenic agents including enteroviruses other than polio, echoviruses, west nile virus, and adenoviruses, among others.
We present our experience of acute onset lower motor neuron paralysis. Acute flaccid paralysis afp is a clinical syndrome characterized by rapid onset of weakness, including less frequently weakness of the muscles of respiration. Most of the conditions are hereditary and are more episodic than periodic. Acute flaccid paralysis in infants and young children with. Clinical management of acute flaccid paralysis acute. Acute flaccid paralysis definition of acute flaccid. A free powerpoint ppt presentation displayed as a flash slide show on id. Acute flaccid weakness may be the first presentation of acute transverse myelitis atm, an immunemediated central nervous system disorder or. Acute flaccid paralysis and its differential diagnosis in. First, clinicians must consider the multiple conditions that can present with flaccid weakness, mimicking afm. Differential diagnosis of afp spinal cord anterior horn cell disease peripheral nerve disorders of neuromuscular. While sub acute evolution may suggest cidp, most of our patients showed a predominantly or exclusively axonal, sensorimotor pattern on ncs, similar to that reported in previous studies. Difficulty moving the eyes, speaking, or swallowing may also occur.
Patients with rapid onset of flaccid paralysis pose a diagnostic and therapeutic challenge to the treating clinician. 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. In response, phe has declared a national incident with the aim of strengthening current surveillance for afpafm and to gather more information on clinical history, possible. See the interim considerations for clinical management for acute flaccid myelitis, or afm. Acute west nile infection and campylobacter have also been associated with afp. Apr 30, 2018 ryan dp, da silva mr, soong tw, et al. 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. None of the patients was diagnosed as having acute poliomyelitis or polio compatible paralysis.
Consider rare causes of paralysis if the diagnosis. History zpatient bz z39 old male zpresented with sudden onset bilateral lower limb paralysis zassociated numbness and paraesthesia involving both limbs zassociated urinary retention zno faecal incontinence, but did. Acute flaccid paralysis is commonly characterized by weakness or paralysis of one limb or one arm. Manual of operations acute flaccid paralysis afp is a syndrome manifested as floppy paralysis. The differential diagnosis of acute flaccid paralysis includes paralytic poliomyelitis, guillainbarre syndrome and transverse myelitis. It affects the nervous system, specifically the area of the spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak we have seen increases in afm cases in. Acute flaccid paralysis afp is a rare but serious neurological illness which is normally due to inflammation of the spinal cord, known as acute. Weakness is noticed first in limb muscles, followed by trunk and respiratory muscles. Differential diagnosis of acute flaccid paralysis and its role in poliomyelitis surveillance, epidemiologic r we use cookies to enhance your experience on our website.
Acute flaccid paralysis surveillance a laboratory perspective. Afaf al areni differential diagnosis of acute weakness. Differential diagnosis of acute flaccid paralysis and its role in poliomyelitis surveillance. It affects the nervous system, specifically the area of the spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak. While subacute evolution may suggest cidp, most of our patients showed a predominantly or exclusively axonal, sensorimotor pattern on ncs, similar to that reported in previous studies. Clarifying the diagnosis of acute flaccid myelitis. Systematic assessment, constructing a differential diagnosis, and rational approach to this problem will help in preventing intercurrent complication of.
Dec 19, 2018 acute flaccid paralysis afp is a rare but serious neurological illness which is normally due to inflammation of the spinal cord, known as acute flaccid myelitis afm. Acute flaccid paralysis occurs due to damage to the peripheral neuron in any part of it. The term flaccid indicates the absence of spasticity or other signs of disordered central nervous system motor tracts such as hyperreflexia, clonus, or. Acute flaccid paralysis afp is a potential outcome of poliovirus infection that involves the acute onset of paralysis in one or more limbs. Differential diagnosis of flaccid paralysis in paediatric. Acute flaccid paralysis afp is a clinical syndrome which has many infectious and noninfectious causes. After the introduction of the term afm in 2014, more than 500 patients, predominantly children, have been recognized both in and outside europe 5, 27, 32, 48. Pdf differential diagnosis of acute flaccid paralysis and its role in. Acute flaccid paralysis afp is a clinical syndrome characterized by rapid onset of weakness, including less frequently weakness of the muscles of respiration and swallowing, progressing to maximum severity within several days to weeks. Ppt acute flaccid paralysis powerpoint presentation.
This case series describes the clinical characteristics and natural course of patients with acute flaccid paralysis reported to the california department of public health between june 2012 and july 2015, and compares case incidence during a us enterovirus d68 outbreak with other monitoring periods. Sep 21, 20 acute flaccid paralysis afp is a complex clinical syndrome with a broad array of potential etiologies that vary with age. With the development of this pathology, muscles lose reflex, as well as arbitrary innervation. Acute flaccid myelitis afm is a syndrome characterized by acute flaccid paralysis afp and gray matter spinal cord lesions on magnetic resonance imaging mri. Statland jm, fontaine b, hanna mg, johnson ne, kissel jt, sansone va, et al.
An accurate and early diagnosis of the cause has important bearing on the management and prognosis. In addition, it should be distinguished from injuries to the tendons, limited movement due to various injuries, as well as from the contracture of the joints. Differential diagnosis of acute flaccid paralysis return to main page aftercornblath2 acute anterior poliomyelitis caused by poliovirus caused by other neurotropic viruses acute myelopathy space occupying lesions acute transverse myelitis peripheral neuropathy all except gbs usually have axonal neurophysiology. Guillainbarre syndrome gbs, an acute inflammatory polyneuropathy, is currently considered the most frequent cause of flaccid paralysis in children.
Trends in acute flaccid myelitis in california, 20122015. Acute onset of focal weakness or paralysis characterized as flaccid reduced tone without other obvious causes e. During the diagnosis it is very important to differentiate the flaccid peripheral paralysis with the central one. Acute paralysis was observed in one upper extremity in two patients, in one lower. Acute flaccid paralysis afp may be caused by a number of agents including enterovirus, echovirus or adenovirus.
Acute flaccid paralysis field manual who emro world health. Review of the diagnosis and treatment of periodic paralysis. It doesnt usually affect both limbs at the same time. Afp is a broad clinical entity with an array of diagnostic possibilities. Google scholar davarpanah m, bakhtiari h, mehrabani d, et al. Paraplegia is impairment in motor and or sensory functions of the lower extremities often including lower part of the trunk. Children with flaccid paralysis will have reduced muscle tone without any obvious cause such as trauma.
Afm interim considerations for clinical management cdc. Pdf the surveillance of acute flaccid paralysis afp is a key strategy for monitoring the progress of poliomyelitis eradication and is a sensitive. This syndrome in a child in fall 2014 was associated with enterovirus c105 infection. Acute flaccid myelitis of unknown etiology in california, 20122015. Differential diagnosis of acute flaccid paralysis and its. The heterogeneous group of muscle diseases known as periodic paralyses pp is characterized by episodes of flaccid muscle weakness occurring at irregular intervals. Acute flaccid myelitiskeys to diagnosis, questions about. Clinical presentation focal weakness or paralysis characterized as flaccid reduced tone without other obvious cause. Acute flaccid myelitis afm is an inflammatory condition of the spinal cord that causes sudden muscle weakness. Acute flaccid paralysis afp is a lower motor neuron lesion. An approach to diagnosis ak yadav, p bhattarai, b ar yal, pp gupta, s chaudhari, a yada v department of general pra ctice and emergency medicine.
Differential diagnosis the differential diagnosis of afm includes a range of infectious and noninfectious causes of acute flaccid paralysis afp, and can be divided into two main categories. Definition sudden onset of weakness or paralysis over a period of 15 days in a patient aged less than 15 years age. Acute flaccid paralysis afp is a clinical syndrome characterized by rapid onset weakness, that many times includes respiratory and bulbar weakness. Sutter, differential diagnosis of acute flaccid paralysis and its role in poliomyelitis surveillance, epidemiologic. Symptoms include rapid onset of arm or leg weakness and decreased reflexes.
A case study r narismulu greys hospital february 2008. Definition of afp sudden onset of weakness or paralysis in a previously normal limb over a period of 15 days in a patient aged less than 15 years age. An outbreak of acute flaccid paralysis among children in the united states during summer 2014 was tentatively associated with enterovirus d68 infection. This abnormal condition may be caused by disease or by trauma affecting the nerves associated with the involved muscles. Acute onset of focal weakness or paralysis characterized as flaccid reduced tone without other obvious cause e. Acute flaccid paralysismyelitis in an individual aged 30 years and under, not explained by an noninfectious cause. Prevention is crucial to stopping disabilities caused by afm. Acute flaccid myelitis afm is a serious condition of the spinal cord. Children with afm present with rapid onset of weakness and sometimes cranial nerve abnormalities, in association with a febrile illness with respiratory. Mar, 2015 guillainbarre syndrome it is an acute idiopathic acquired inflammatory demyelinating polyneuropathy. Acute flaccid paralysis with anterior myelitis, poliolike syndrome 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. Hsv, bacterial meningitis, guillainbarre syndrome csf. One hundred and thirtythree consecutive adult patients presenting.
A 12years surveillance of poliomyelitis and acute flaccid paralysis in fars province, southern iran. Acute flaccid paralysis and its differential diagnosis in in. Acute flaccid myelitis is defined as the acute onset of flaccid paralysis in the setting of a longitudinal lesion of the spinal cord that affects primarily the central gray matter. Differential diagnosis of flaccid paralysis in paediatric medicine. As mentioned in the methods, an easily discernible response to treatment was a major factor in the diagnosis of these patients. Acute flaccid myelitis afm is a rare but serious neurologic condition. The presence of this virus strain in north america may pose a diagnostic challenge. Differential diagnosis of acute flaccid paralysis and its role in. Paralytic symptoms generally begin 1 to 10 days after prodromal symptoms and progress for 2 to 3 days. Public health england has received an increase in reports of acute flaccid paralysis and acute flaccid myelitis afpafm cases in england, particularly since september 2018. There is no definitive cause of acute flaccid myelitis afm. By continuing to use our website, you are agreeing to our use of cookies. Pdf differential diagnosis of acute flaccid paralysis and. The surveillance of acute flaccid paralysis afp is a key strategy for monitoring the progress of poliomyelitis eradication and is a sensitive measure for detecting potential cases of poliomyelitis and poliovirus infection.
Acute poliomyelitis is a disease of the anterior horn motor neurons of the spinal cord and brain stem caused by poliovirus. Guillainbarre syndrome was the most frequent final diagnosis 79. In addition, it should be distinguished from injuries to the tendons, limited movement due to various injuries, as well as from the contracture. Acute flaccid paralysis afp is a clinical syndrome char acterized by rapid onset of weakness, including less fre quently weakness of the muscles of. Flaccid paralysis is a neurological condition characterized by weakness or paralysis and reduced muscle tone without other obvious cause e. Differential diagnosis of acute flaccid paralysis return to main page aftercornblath2 acute anterior poliomyelitis caused by poliovirus caused by other neurotropic viruses acute myelopathy space occupying lesions acute transverse myelitis peripheral neuropathy all. 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. Acute flaccid paralysis and its differential diagnosis in in kurdistan. Trends in acute flaccid myelitis in california, 20122015 jama. Jan 03, 20 differential diagnosis of acute flaccid paralysis and its role in poliomyelitis surveillance. Differential diagnosis of acute flaccid paralysis and its role in poliomyelitis surveillance, epidemiologic r. Ppt acute flaccid paralysis powerpoint presentation free.
Early screening, detection, and diagnosis are necessary for rapid treatment. Acute flaccid myelitis offers an appropriately descriptive term for the syndrome. Acute flaccid paralysis afp is a complex clinical syndrome with a broad array of potential etiologies that vary with age. Pdf acute flaccid paralysis and its differential diagnosis in in. Paralysis is a symptom of a wide variety of physical and emotional disorders rather than a disease in itself. If an alternative diagnosis for the acute paralysis is. Gbs is the most common cause of acute flaccid paralysis in healthy infants and children. Causes and differential diagnosis of acute flaccid paralysis.
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