Acute Flaccid Paralysis

Acute flaccid paralysis is rapid onset weakness with reduced tone and usually reduced reflexes. It is a syndrome requiring urgent evaluation, both because respiratory failure can develop and because poliomyelitis surveillance depends on recognition of every compatible case.

Causes include Guillain Barré syndrome, poliomyelitis, transverse myelitis, botulism, hypokalaemia and spinal cord disease.

• Acute limb weakness
• Flaccid tone
• Reduced or absent reflexes
• Difficulty walking
• Bulbar weakness
• Respiratory weakness

Sensory symptoms, autonomic instability, bladder dysfunction or a sensory level help localize the lesion.

• Assess respiratory function immediately.

• Measure vital capacity where available.

• Check electrolytes, particularly potassium.

• CSF may demonstrate albuminocytological dissociation in Guillain Barré syndrome.

• MRI spine is indicated when spinal cord compression or transverse myelitis is possible.

• Obtain stool specimens promptly where poliomyelitis surveillance is required.

• Admit children with progressive weakness.

• Monitor respiratory function, swallowing and autonomic status.

• Treat the specific cause.

• Do not wait for overt hypoxaemia before recognizing neuromuscular respiratory failure because oxygen saturation can remain normal until late.

• Notify public health surveillance systems promptly when poliomyelitis is a possibility.