Recognition and Management of Acute Flaccid Myelitis in Children
Recognition and Management of Acute Flaccid Myelitis in Children
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DOI：
10.1016/j.pediatrneurol.2015.10.007
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发表时间：
2016-02-01
影响因子：
3.8
通讯作者：
Bale, James F., Jr.
中科院分区：
文献类型：
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作者：
Nelson, Gary R.;Bonkowsky, Joshua L.;Bale, James F., Jr.
背景：2014-2015年，美国多个地区爆发了儿童患者急性弛缓性脊髓炎。一个共同而独特的特征是疾病定位于脊髓灰质。方法：我们报告了西山间的 11 名儿童，年龄为 13 个月至 14 岁（中位 9 岁），他们出现不同严重程度的四肢无力 (n = 10) 或颅神经病变 (n = 1)，但没有明显的病因。结果：所有儿童均出现急性瘫痪，其中 10 名儿童出现局限于脊髓的症状或体征。所有患者均在发病后 4 天内出现最大程度的瘫痪。磁共振成像检测发现，所有患者均患有与急性脊髓炎相符的脊髓灰质病变；没有发现任何单一的感染原因。尽管使用静脉注射免疫球蛋白、皮质类固醇或血浆置换进行治疗，但 10 名儿童中有 9 名 (90%) 在随访时出现运动缺陷。结论：对这种疾病的认识使临床医生能够获得适当的影像学和实验室检测、开始治疗并为家庭提供准确的预后信息。与儿童期急性弛缓性麻痹的其他原因相比，大多数急性弛缓性脊髓炎儿童都有残留的神经功能缺损。
BACKGROUND: In 2014-2015, several regions of the United States experienced an outbreak of acute flaccid myelitis in pediatric patients. A common, unique feature was disease localization to the gray matter of the spinal cord. METHODS: We report 11 children, ages 13 months to 14 years (median 9 years), in the Intermountain West who presented with extremity weakness (n = 10) or cranial neuropathy (n =1) of varying severity without an apparent etiology. RESULTS: All children experienced acute paralysis, and 10 had symptoms or signs that localized to the spinal cord. Maximum paralysis occurred within 4 days of onset in all patients. All had spinal gray matter lesions consistent with acute myelitis detected by magnetic resonance imaging; no single infectious cause was identified. Despite therapy with intravenous immunoglobulin, corticosteroids, or plasma exchange, nine of 10 (90%) children had motor deficits at follow-up. CONCLUSIONS: Recognition of this disorder enables clinicians to obtain appropriate imaging and laboratory testing, initiate treatment, and provide families with accurate prognostic information. In contrast to other causes of acute flaccid paralysis in childhood, most children with acute flaccid myelitis have residual neurological deficits.