title: Recognition and Management of Acute Flaccid Myelitis in Children.
abstract: BACKGROUND
  In 2014-2015, several regions of the United States experienced an outbreak of acute flaccid myelitis in pediatric patients. A common, unique feature was disease localization to the gray matter of the spinal cord.
  
  
  METHODS
  We report 11 children, ages 13 months to 14 years (median 9 years), in the Intermountain West who presented with extremity weakness (n = 10) or cranial neuropathy (n = 1) of varying severity without an apparent etiology.
  
  
  RESULTS
  All children experienced acute paralysis, and 10 had symptoms or signs that localized to the spinal cord. Maximum paralysis occurred within 4 days of onset in all patients. All had spinal gray matter lesions consistent with acute myelitis detected by magnetic resonance imaging; no single infectious cause was identified. Despite therapy with intravenous immunoglobulin, corticosteroids, or plasma exchange, nine of 10 (90%) children had motor deficits at follow-up.
  
  
  CONCLUSIONS
  Recognition of this disorder enables clinicians to obtain appropriate imaging and laboratory testing, initiate treatment, and provide families with accurate prognostic information. In contrast to other causes of acute flaccid paralysis in childhood, most children with acute flaccid myelitis have residual neurological deficits.
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah. Electronic address: gary.nelson@hsc.utah.edu.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Nelson
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Bonkowsky
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Doll
authors.affiliation: Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Michael
authors.initials: M
authors.lastname: Green
authors.affiliation: Department of Medical Imaging, Primary Children's Hospital, Salt Lake City, Utah; Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Hedlund
authors.affiliation: Department of Medical Imaging, Primary Children's Hospital, Salt Lake City, Utah; Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Moore
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: James F
authors.initials: JF
authors.lastname: Bale
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003389:Cranial Nerve Diseases / Q000175:diagnosis*; D005260:Female; D066128:Gray Matter / Q000473:pathology*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009187:Myelitis / Q000175:diagnosis*; D015205:Northwestern United States; D010243:Paralysis / Q000175:diagnosis*
keywords: Guillain-Barré syndrome; enterovirus; flaccid paralysis; myelitis; poliomyelitis