Nath Rahul Kumar, Somasundaram Chandra
Department of Surgical Research, Texas Nerve and Paralysis Institute, Houston, TX, USA.
Am J Case Rep. 2019 May 10;20:668-673. doi: 10.12659/AJCR.915235.
BACKGROUND Acute flaccid myelitis is an emerging polio-like illness mostly affecting young children, characterized by rapid onset of extremity weakness and paralysis in 1 or more limbs. Certain viruses, including enteroviruses such as EV-68, EV-71, poliovirus, and West Nile virus, can cause this disorder. The largest known outbreak of EVD68 in the United States was in the summer of 2014, causing severe respiratory illness and acute flaccid myelitis, mainly in young children. Furthermore, the US Centers for Disease Control and Prevention noted an increase in the number of patients with clinical symptoms of acute flaccid myelitis in 2018, and 134 confirmed cases by December 2018 were reported in the USA. CASE REPORT The patient in our present study was a 5-year-old female who had significant weakness and paralysis in all 4 extremities due to acute flaccid myelitis. EV-D68 had caused this disorder in this patient in August 2014. Conservative management had not helped her condition. Specific areas of concern were both shoulders and biceps, and the femoral and peroneal nerves in both sides. Of these, the right shoulder function was the worst, at less than grade 3. The patient also had marked atrophy and weakness of the right quadricep muscles. The patient underwent surgical treatment and had steady improvements in all 4 extremity functional movements. CONCLUSIONS We demonstrated that decompression, neurolysis, and nerve transfer surgical procedures can be used successfully to correct the paralyzed upper and lower extremity movements in acute flaccid myelitis patients.
急性弛缓性脊髓炎是一种新出现的类脊髓灰质炎疾病，主要影响幼儿，其特征为1个或多个肢体迅速出现肢体无力和麻痹。某些病毒，包括肠道病毒如EV - 68、EV - 71、脊髓灰质炎病毒和西尼罗河病毒，可导致这种疾病。美国已知最大规模的EV - D68疫情发生在2014年夏天，导致严重的呼吸道疾病和急性弛缓性脊髓炎，主要发生在幼儿中。此外，美国疾病控制与预防中心指出，2018年急性弛缓性脊髓炎临床症状患者数量有所增加，截至2018年12月，美国报告了134例确诊病例。病例报告：我们本研究中的患者是一名5岁女性，因急性弛缓性脊髓炎导致四肢严重无力和麻痹。2014年8月，EV - D68导致该患者出现这种疾病。保守治疗对她的病情没有帮助。需要特别关注的特定部位是双肩和双侧肱二头肌以及双侧股神经和腓总神经。其中，右肩功能最差，低于3级。患者右侧股四头肌也有明显萎缩和无力。患者接受了手术治疗，四肢功能运动均有稳步改善。结论：我们证明，减压、神经松解和神经移植手术程序可成功用于纠正急性弛缓性脊髓炎患者瘫痪的上肢和下肢运动。
