Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30001, 9700 RB, Groningen, The Netherlands.
Department of Medical Microbiology and Infection Prevention, Division of Clinical Virology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Eur J Pediatr. 2019 Sep;178(9):1305-1315. doi: 10.1007/s00431-019-03435-3. Epub 2019 Jul 23.
Acute flaccid myelitis is characterized by the combination of acute flaccid paralysis and a spinal cord lesion largely restricted to the gray matter on magnetic resonance imaging. The term acute flaccid myelitis was introduced in 2014 after the upsurge of pediatric cases in the USA with enterovirus D68 infection. Since then, an increasing number of cases have been reported worldwide. Whereas the terminology is new, the clinical syndrome has been recognized in the past in association with several other neurotropic viruses such as poliovirus.Conclusion: This review presents the current knowledge on acute flaccid myelitis with respect to the clinical presentation and its differential diagnosis with Guillain-Barré syndrome and acute transverse myelitis. We also discuss the association with enterovirus D68 and the presumed pathophysiological mechanism of this infection causing anterior horn cell damage. Sharing clinical knowledge and insights from basic research is needed to make progress in diagnosis, treatment, and prevention of this new polio-like disease. What is Known: • Acute flaccid myelitis (AFM) is a polio-like condition characterized by rapid progressive asymmetric weakness, together with specific findings on MRI • AFM has been related to different viral agents, but recent outbreaks are predominantly associated with enterovirus D68. What is New: • Improving knowledge on AFM must increase early recognition and adequate diagnostic procedures by clinicians. • The increasing incidence of AFM urges cooperation between pediatricians, neurologists, and microbiologists for the development of treatment and preventive options.
急性弛缓性脊髓炎的特征是急性弛缓性瘫痪与脊髓病变相结合，磁共振成像上病变主要局限于灰质。急性弛缓性脊髓炎一词于 2014 年在美国小儿病例因肠道病毒 D68 感染而激增后引入。此后，世界范围内报告的病例越来越多。虽然术语是新的，但过去已经认识到这种临床综合征与其他几种神经营养性病毒有关，如脊髓灰质炎病毒。结论：本文就急性弛缓性脊髓炎的临床表现及其与吉兰-巴雷综合征和急性横贯性脊髓炎的鉴别诊断进行了综述。我们还讨论了与肠道病毒 D68 的关系以及这种感染导致前角细胞损伤的假定病理生理机制。为了在这种新的类似脊髓灰质炎的疾病的诊断、治疗和预防方面取得进展，需要分享临床知识和基础研究的见解。已知的：•急性弛缓性脊髓炎（AFM）是一种类似脊髓灰质炎的疾病，其特征是迅速进展的不对称性无力，以及 MRI 上的特定发现；•AFM 与不同的病毒因子有关，但最近的疫情主要与肠道病毒 D68 有关。新的：•提高对 AFM 的认识必须提高临床医生的早期识别和充分的诊断程序。•AFM 的发病率不断上升，促使儿科医生、神经科医生和微生物学家合作开发治疗和预防方案。
