J Korean Child Neurol Soc.  2013 Sep;21(3):208-212.

A Case of Combined Acute Disseminated Encephalomyelitis and Acute Flaccid Paralysis associated with Enteroviral Infection

• Lee J
• Choi Y
• Rhie S
• Jang SJ
• Chae KY

Abstract

Enterovirus infection is often aggravated and manifests as various neurological complications such as aseptic meningitis, brainstem encephalitis, poliomyelitis-like acute flaccid paralysis, transverse myelitis, and severe systemic diseases. There are a few reports indicating that enterovirus is associated with acute disseminated encephalomyelitis (ADEM), acute flaccid paralysis, or Guillain-Barre syndrome separately. However, none of these report ADEM and acute flaccid paralysis occurring simultaneously. Here, we present a case of combined ADEM and acute flaccid paralysis associated with enteroviral infection in a child and reviewed the relevant literature. A 5-year-old boy was admitted to the hospital for headache and vomiting with evident meningeal irritation signs. Despite of antibiotic therapy, his mental state rapidly declined to coma with abnormal upper motor neuron (UMN) signs. During 5 consecutive days of steroid pulse therapy, his abnormal UMN signs abruptly changed to flaccid paralysis. Suspected acute flaccid paralysis due to enterovirus prompted the addition of intravenous immunoglobulin (IVIG). On hospital day 33, he was discharged with full recovery of muscle tone and strength with an alert mental state.

Keyword

Encephalomyelitis; Acute Disseminated; Muscle Hypotonia; Attention Deficit Disorder with Hyperactivity; Enterovirus

MeSH Terms

Attention Deficit Disorder with Hyperactivity
Brain Stem
Child
Child, Preschool
Coma
Encephalitis
Encephalomyelitis
Encephalomyelitis, Acute Disseminated*
Enterovirus
Enterovirus Infections
Guillain-Barre Syndrome
Headache
Humans
Immunoglobulins
Male
Meningitis, Aseptic
Motor Neurons
Muscle Hypotonia
Muscles
Myelitis, Transverse
Paralysis*
Vomiting
Immunoglobulins