Acute Flaccid Myelitis — Differential Diagnosis — Clinical Pathway: Emergency and Inpatient

Evaluation of Suspected Acute Flaccid Myelitis Clinical Pathway — Emergency and Inpatient

Differential Diagnosis

Importance of Reassessment

Signs and symptoms of AFM can also be seen with other diagnoses, a high index of suspicion is essential.

Disease Signs
Guillain-Barre Syndrome
  • Ascending and symmetric weakness
  • More sensory involvement
  • Decreased, absent deep tendon reflexes
Demyelinating myelitis
(e.g. aquaporin-4-IgG seropositive or seronegative neuromyelitis optica spectrum disorder [NMOSD], transverse myelitis)

Myelin oligodendrocyte glycoprotein [MOG]-antibody associated myelitis

Multiple sclerosis

Acute disseminated encephalomyelitis
  • Tend to be symmetric weakness
  • More sensory involvement
  • Increased deep tendon reflexes
Spinal cord or cerebral stroke
  • Hyperacute onset
Acute brachial plexopathy
  • Unilateral arm involvement
  • Pattern of weakness, sensory change consistent with peripheral nerve injury
  • Typically painful
Infantile Botulism
  • Descending paralysis
  • Symmetric cranial nerve
  • Upper and lower extremity involvement
  • Age < 1 year
  • Normal spinal cord
Spinal cord compressive lesion
  • Often includes sensory symptoms
  • Urinary or bowel dysfunction
  • May be symmetric or asymmetric
Transient (toxic) synovitis, infectious (septic) arthritis, osteomyelitis, or trauma
  • Refusal to use a single limb, with bony tenderness. Refusal to use a limb may be due to pain with ROM of a joint which can mask neurologic symptoms