Importance of Selected Acute Flaccid Paralysis Diagnoses in an Emergency Department Setting for the Pediatric Population

Abstract

A review for the bedside practitioner of practical clinical exam, subtle differences, and diagnostic criteria for some of the difficult to distinguish acute flaccid paralysis diagnoses in the pediatric patient and to summarize the current findings of the evolving and elusive diagnosis termed acute flaccid myelitis. Since the first public epidemiological reports in 2014 using the newly coined diagnosis of acute flaccid myelitis (AFM), emergency department clinicians and other frontline medical professionals have become primarily responsible for identifying patients who may become subsequently critically ill. New research has identified a causal relationship between a specific enterovirus strain and AFM subsequently adding to the required neurologic differential diagnosis for the bedside clinician. Despite the seemingly intimidating diagnostic challenges of distinguishing various ailments under the umbrella of acute flaccid paralysis, the more potentially devastating but not as obvious diagnoses of Guillain-Barre syndrome and acute transverse myelitis should be considered with any reports in the pediatric patient of limb or sensory disorder, especially in the absence of other systemic or traumatic explanations. Likewise, acute flaccid myelitis is a diagnosis that the bedside emergency department clinician should be both aware of and pursue along with other entities in the differential diagnosis.