Acute Flaccid Myelitis With Neuroradiological Finding of Brachial Plexus Swelling - 23/07/20

Doi : 10.1016/j.pediatrneurol.2020.04.004

Pin Fee Chong, MD ^a,^⁎ , Takeshi Yoshida, MD, PhD ^b, Shota Yuasa, MD ^c, Harushi Mori, MD, PhD ^d, Keiko Tanaka-Taya, MD, PhD ^e, Ryutaro Kira, MD, PhD ^a
^a Department of Pediatric Neurology, Fukuoka Children’s Hospital, Fukuoka, Japan
^b Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
^c Department of Pediatrics, Kameda Medical Center, Chiba, Japan
^d Department of Radiology, Graduate School and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
^e Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan

^∗Communications should be addressed to: Chong; Department of Pediatric Neurology; Fukuoka Children’s Hospital; 5-1-1 Kashiiteriha; Higashi-ku, Fukuoka 813-0017, Japan.Department of Pediatric NeurologyFukuoka Children’s Hospital5-1-1 KashiiterihaHigashi-kuFukuoka813-0017Japan

Abstract

Background

Acute flaccid myelitis is a recently defined clinically distinct syndrome of polio-like acute flaccid paralysis. Acute flaccid myelitis cases show characteristic neuroradiological features of longitudinal spinal cord lesions with predominant gray matter involvement. Current evidence suggests injury to the anterior horn neurons as the underlying mechanism.

Methods

We describe three patients with acute flaccid myelitis who developed flaccid upper limb weakness with diminished deep tendon reflexes after prodromal fever. Spinal magnetic resonance imaging (MRI) (axial and sagittal T1- and T2-weighted sequences) and brachial plexus MRI (coronal short tau inversion recovery sequence) at the acute stage were performed.

Results

Spinal MRI showed extensive longitudinal lesion in the spinal cord with predominant gray matter involvement. We were able to demonstrate concurrent swelling and hyperintensity in the brachial plexus in all the three patients at the acute stage.

Conclusion

The coexisting signal intensities suggest an extension of acute flaccid myelitis pathology to the brachial plexus, highlighting the possible peripheral nerve involvement in acute flaccid myelitis.

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Keywords : Acute flaccid myelitis, Brachial plexus swelling, Peripheral nerve, MR neurography, STIR

Plan

Declaration of interest: The authors declare no conflicts of interests.

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Vol 109

P. 85-88 - août 2020 Retour au numéro

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Acute Flaccid Myelitis With Neuroradiological Finding of Brachial Plexus Swelling - 23/07/20

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