Last modified: 2018-09-09
Abstract
Background: Anterior horn cell myelitis is a relatively uncommon cause of acute flaccid paralysis in children.
Methodology: A retrospective study of all children admitted to the tertiary care hospital from July-September 2017 with a final clinico-radiological diagnosis of acute anterior horn cell myelitis was conducted. A pre-determined proforma was used to collect data. They were followed up for a variable period from the time of discharge, and clinical outcomes were recorded.
Results: During this period, a cluster of 10 cases of long-segment myelitis were admitted. Asymmetric quadriparesis was the most common pattern of weakness (5/10), and a descending pattern was seen in 4 of these patients. Two patients presented with isolated monoparesis of the upper limb. Sensory loss and bladder/bowel involvement were seen in none. A viral prodrome (<1 week) was present in 6/10 of patients. Initial MRI of the spine revealed long-segment myelitis in all patients. All patients showed no to minimal improvement in power with persistent areflexia, flaccidity, and wasting of the affected limbs during a median follow up nine months post-discharge.
Conclusions:
Neuroimaging findings are similar to acute transverse myelitis in the acute stage. The prognosis of this disorder as regards to the return of motor function appears to be uniformly poor. Clinical features including patchy motor involvement and sparing of the bladder and sensory functions, along with a high degree of suspicion based on a seasonal clustering of cases, may be useful in early identification and prognostication as well as avoidance of unnecessary therapy.