Poliomyelitis ElectrodiagnosisDr Mohamed ibrahim khalilphysical medicine Rheumatology and rehabilitation , Alexandria University EGYPT

To contact Dr M. IbrahimReverie-forever@hotmail.com

History

A 1.5 year-old child named Abdel-Rahman Ali Basiouny presented with weakness of left upper and lower limb and inability to walk of 2 days duration

• The condition started 20 days ago with acute onset of high fever (39 C ) and common cold which Resolved on medical tratment

• A week later the high fever recurred and associated with Acute severe weakness of left upper and lower limbs and inability to walk

After three days the fever resolved on medical treatment while the weakness Persists ( The weakness was maximum from the start )

** MRI Brain was done which revealed normal findings .

The patient then refered to do electrophysiological study .

• No history of similar attacks • No history of head trauma• No history of change of consciousness• No history of convulsions • NO history of involuntary movements

• Past Medical History : Irrelvant

• Family History : Irrelevant

• Vital signs :

Pulse 95 b/min

Respiration 16 /min

Blood Pressure 125/90

Temperature 37 C

Physical examination

1- Mental or intellectual function:

• The Patient is fully conscious, alert oriented

2- Speech and articulation : Normal

3- Cranial nerves : Free

4- Sensory examination : intact5- Gait : inability to walk 6- Motor examination :• Muscle state : Normal • Muscle Tone :HYPOTONIA on Left upper

and lower Limbs • No involuntary movements • No fasiculations

Muscle Power examination :

Power examination of muscles on the right side of the body is completely normal ( G 5 )

Most of the muscles on the left side of the body is affected except :

Wrist flexors G5Planter flexor G

5Triceps G5

Muscle Power examination :

• Inability to raise arm ( Deltoid Grade ZERO )

Power examination :

• Moderate Left hip flexion ( G 3 )

• Inability to extend the left Knee extension (quadriceps G 0 )

Power examination :

Muscle Power examination :

• Biceps : G 3

• Wrist extensors G 2

• Hand muscles : G 3

• Hip flexors : G 4

• Hip extensors : G 3

• Hamestrings : G 3

• Dorsiflexors : G 4

Right side reflexes : Normal

Left side reflexes :

• Abscent Knee reflex

• Present ankle reflex

• Abscent biceps reflex

Negative extensor planter sign

Reflexes examination :

Pathological Reflexes :• Flexor planter

Reflexes examination :

Differential diagnosis

1. Guillian Barre Syndrome

2. Encephalitis

3. Menengitis

4. Poliomyelitis

5. Polio-Like

Right Left

Median 6.3 3.2

Axillary 1.83 0.6

Femoral 1.97 0.63

Posterior tibial

11.7 11.3

Deep peroneal

7.5

Ulnar 4..6

Diagnosis

• Multiple Patchy Axonopathic LMNL Suggestive of

Where is Polio present Where is Polio present TODAYTODAY

• In 2008, only four countries in the world remain with polio-endemic, down from more than 125 in 1988. The remaining countries are Afghanistan, India, Nigeria and Pakistan.

04/10/23 Dr.T.V.Rao MD 32

Polio – like syndromes

• patients with suspected poliomyelitis, but from whom poliovirus was not isolated, a variety of causes of the paralysis was found.

• Enterovirus infections, especially coxsackieviruses A9 and A23 (echovirus 9) and group B coxsackieviruses, frequently caused meningoencephalitis often associated with transient paralysis. Coxsackievirus A7 infection occasionally resulted in permanent paralysis.

• Exotic causes included paralysis due to snake bite, spider bite, scorpion sting, and tick bite and schistosomiasis involving the spinal cord

• Chemical poisons, such as arsenic, triorthocresyl phosphate, and organophosphorus insecticides,

• Paralysis in individual patients with porphyria followed the administration of anesthesia and certain drugs.

• The Guillain-Barré syndrome in some patients resulted from virus infection of the nerve tissue, in others it was related to a hyperreactive autoallergic state.

• Injury of the spinal column sometimes followed by periostitis or osteomyelitis was relatively common.

04/10/23 Dr.T.V.Rao MD 47