Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children

Since August 2014 there has been several reports in the US and Canada of children presenting with mostly focal limb weakness following recent respiratory tract infection and associated significant grey matter changes on spinal MRI.

The Centers for Disease Control and Prevention (CDC) is working closely with the Colorado Department of Public Health and Environment (CDPHE) and Children's Hospital Colorado to investigate a cluster of nine pediatric patients hospitalized with acute neurologic illness of undetermined etiology. The CDC have also put out a HAN (Health Alert Network) Advisory with guidance about reporting cases to state and local health departments.

13-year-old Will Cornejo of Lone Tree, Colo., recovers at Rocky Mountain Hospital for Children in Denver from what doctors suspect is enterovirus 68Dr Ann Yeh, University of Toronto says that over the last several weeks, the Hospital for Sick Children, in Toronto, have seen a cluster of children presenting with transverse myelitis with atypical neuroimaging findings involving significant grey matter involvement and in some case brain stem involvement With the risk of limited recovery given the extensive grey matter involvement at the Hospital for Sick Children they have taken an aggressive approach upfront with treatment with steroids and early plasma exchange if steroids are ineffective. They have reported some recovery with this treatment.

It is also not clear whether this could represent an infectious process (similar to polio) or post-infectious process and what the inciting agent might be. The neuroinflammation service at SickKids (Ann Yeh) is available to provide advice on any suspect cases.

Investigations are currently ongoing to find out whether these presentations are linked to the nationwide outbreak of EV-D68 associated with severe respiratory disease currently seen in North America.

View the CDC Official Health Advisory here

CDC Investigates Limb Paralysis in Children After Enterovirus 68 Outbreak (ABC News)

Enterovirus D68 (wikipedia )