Acute Flaccid Myelitis — High Suspicion of AFM — Clinical Pathway: Emergency and Inpatient

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

High Suspicion of AFM

H/P Findings

  • Signs and Symptoms that suggest AFM

  • One or more flaccid/floppy/low tone extremities with or without cranial nerve abnormalities and bulbar weakness
    • e.g. Difficulty swallowing/holding head up
  • Proximal > distal weakness
  • Decreased or absent deep tendon reflexes in the affected extremity
  • Recent or current febrile illness
  • Pain in the affected extremity is a common finding
  • May have recent history of:
    • Using one arm more than the other
    • Frequent falls
    • Refusal to walk
Lab Findings
  • Respiratory sample positive for enterovirus
  • CSF with lymphocytic pleocytosis
    • (supportive, but not required for diagnosis)
MRI Findings
  • Lesions (typically longitudinally extensive) involving gray matter of the spinal cord are required to confirm diagnosis
  • If history and exam are concerning, follow-up imaging may be necessary (in rare cases, imaging may be read normal at onset)