Eliza Gordon-Lipkin1,2, Laura S Muñoz1, Jessica L Klein3, Janet Dean2, Izlem Izbudak4, Carlos A Pardo1,5. 1. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 2. Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA. 3. Department of Pediatrics, Division of Pediatric Neurology, Medical University of South Carolina, Charleston, SC, USA. 4. Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 5. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Abstract
AIM: To quantify characteristics in acute flaccid myelitis (AFM) at acute and convalescent stages. METHOD: This was a retrospective case series of children with AFM evaluated at a single institution in the USA (2014-2017). Acute inflammatory/ischemic myelopathies were excluded. Neurological assessments and segmental quantitative analysis of signal abnormalities on magnetic resonance imaging (MRI) of the brain and spinal cord were performed. RESULTS: Sixteen patients (11 males, five females) were evaluated. Median age at onset was 4 years (interquartile range [IQR] 3-6y). All had parainfectious acute-onset limb weakness, lower motor neuron examination, and spinal fluid pleocytosis. On acute spinal cord MRI, longitudinally extensive T2 hyperintensities were identified throughout the spinal cord mostly within grey matter; five out of 12 patients had dorsal brainstem T2 hyperintensities. At a median of 2 months follow-up (IQR 2-3mo), spinal cord MRI improved in seven out of nine patients although focal T2 hyperintensities persisted in cervical and lumbar grey matter. At a median follow-up of 4 months (IQR 2-6mo), Medical Research Council sum score rose from a median of 29 to 32; distal muscle groups improved more than proximal ones; four out of 16 patients were ventilator-dependent; and two out of 16 patients were quadriplegic. INTERPRETATION: While patients may show marked improvement on neuroimaging from acute to convalescent stages, the majority of children with AFM have limited motor recovery and continued disability. Clinicians should consider the timing of clinical and neuroimaging exams when assessing diagnosis and prognosis. WHAT THIS PAPER ADDS: During the 2014 to 2017 acute flaccid myelitis outbreak in the USA, clinical recovery was better in distal than proximal muscle groups. Lumbar spinal cord showed more residual abnormalities at convalescence.
AIM: To quantify characteristics in acute flaccid myelitis (AFM) at acute and convalescent stages. METHOD: This was a retrospective case series of children with AFM evaluated at a single institution in the USA (2014-2017). Acute inflammatory/ischemic myelopathies were excluded. Neurological assessments and segmental quantitative analysis of signal abnormalities on magnetic resonance imaging (MRI) of the brain and spinal cord were performed. RESULTS: Sixteen patients (11 males, five females) were evaluated. Median age at onset was 4 years (interquartile range [IQR] 3-6y). All had parainfectious acute-onset limb weakness, lower motor neuron examination, and spinal fluid pleocytosis. On acute spinal cord MRI, longitudinally extensive T2 hyperintensities were identified throughout the spinal cord mostly within grey matter; five out of 12 patients had dorsal brainstem T2 hyperintensities. At a median of 2 months follow-up (IQR 2-3mo), spinal cord MRI improved in seven out of nine patients although focal T2 hyperintensities persisted in cervical and lumbar grey matter. At a median follow-up of 4 months (IQR 2-6mo), Medical Research Council sum score rose from a median of 29 to 32; distal muscle groups improved more than proximal ones; four out of 16 patients were ventilator-dependent; and two out of 16 patients were quadriplegic. INTERPRETATION: While patients may show marked improvement on neuroimaging from acute to convalescent stages, the majority of children with AFM have limited motor recovery and continued disability. Clinicians should consider the timing of clinical and neuroimaging exams when assessing diagnosis and prognosis. WHAT THIS PAPER ADDS: During the 2014 to 2017 acute flaccid myelitis outbreak in the USA, clinical recovery was better in distal than proximal muscle groups. Lumbar spinal cord showed more residual abnormalities at convalescence.
Authors: Matthew J Elrick; Eliza Gordon-Lipkin; Thomas O Crawford; Keith Van Haren; Kevin Messacar; Nicole Thornton; Elizabeth Dee; Annie Voskertchian; Jessica R Nance; Laura S Muñoz; Mark P Gorman; Leslie A Benson; David L Thomas; Carlos A Pardo; Aaron M Milstone; Priya Duggal Journal: JAMA Pediatr Date: 2019-02-01 Impact factor: 16.193
Authors: Olwen C Murphy; Kevin Messacar; Leslie Benson; Riley Bove; Jessica L Carpenter; Thomas Crawford; Janet Dean; Roberta DeBiasi; Jay Desai; Matthew J Elrick; Raquel Farias-Moeller; Grace Y Gombolay; Benjamin Greenberg; Matthew Harmelink; Sue Hong; Sarah E Hopkins; Joyce Oleszek; Catherine Otten; Cristina L Sadowsky; Teri L Schreiner; Kiran T Thakur; Keith Van Haren; Carolina M Carballo; Pin Fee Chong; Amary Fall; Vykuntaraju K Gowda; Jelte Helfferich; Ryutaro Kira; Ming Lim; Eduardo L Lopez; Elizabeth M Wells; E Ann Yeh; Carlos A Pardo Journal: Lancet Date: 2020-12-23 Impact factor: 79.321
Authors: Travis L Edmiston; Mathew J Elrick; Mark L Kovler; Eric B Jelin; Raymond P Onders; Cristina L Sadowsky Journal: Spinal Cord Ser Cases Date: 2019-07-17
Authors: Jelte Helfferich; Marjolein Knoester; Coretta C Van Leer-Buter; Rinze F Neuteboom; Linda C Meiners; Hubert G Niesters; Oebele F Brouwer Journal: Eur J Pediatr Date: 2019-07-23 Impact factor: 3.183