Acute Flaccid Myelitis — Monitoring — Clinical Pathway: Emergency and Inpatient

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

Monitoring

Admission Criteria > 48 Hours of Clinical Findings
Without Progression		 ≤ 48 Hours of Clinical Findings or Concern for Progressive Symptoms, Bulbar or Cranial Nerve Dysfunction, Cervical Lesions, or Abnormal NIF
Unit Neurology PICU
Additional Testing
  • Obtain imaging and/or LP if not done in ED
  • Consider additional laboratory studies
  • Consider EMG for prognosis if minimal recovery 1-2 weeks after presentation
Monitor
  • Vital signs, neurologic status, respiratory function (NIF), post void residual, stool output
Pain
  • Gabapentin as 1st line treatment for neuropathic pain associated with AFM
Considerations
  • Consider CAT if:
  • Concern for progressive bulbar symptoms
  • Respiratory insufficiency
  • Supplemental oxygen required
  • Other concerns for decompensation
  
Consults
  • Rehabilitation, PT/OT, Speech
  • Consider:
    • Infectious Disease for guidance on additional testing
    • Behavioral Medicine/Social Work for coping strategies
Reporting
  • Report to CDC   if flaccid weakness with gray matter involvement on MRI