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Nonpoliovirus Poliomyelitis Simulating Guillain-Barré Syndrome
Kenneth C. Gorson, MD;
Allan H. Ropper, MD
Arch Neurol. 2001;58:1460-1464.
Background Paralytic poliomyelitis due to the wild-type poliovirus has been eradicated
in the United States because of effective immunization programs. In the postvaccination
era, most cases are caused by other RNA viruses, such as coxsackievirus or
echovirus. The condition usually begins with a fever and upper respiratory
tract or gastrointestinal tract symptoms that progress to a "paralytic" phase
characterized by limb weakness, areflexia, and, occasionally, respiratory
failure that superficially resemble Guillain-Barré syndrome.
Objective To describe 2 patients with nonpoliovirus poliomyelitis and highlight
the findings on magnetic resonance imaging of the spinal cord to distinguish
these cases from variants of Guillain-Barré syndrome.
Design and Setting Case series from an academic medical center.
Patients Following a viral illness, the patients, aged 35 and 50 years, had painless,
progressive, asymmetrical weakness in the arms followed by respiratory failure
in one patient, and generalized limb weakness in the other patient, reaching
a nadir in 1 week. Both patients had fevers but no signs of meningitis at
onset. Tendon reflexes were absent or reduced in affected regions. The cerebrospinal
fluid findings were as follows: mononuclear leukocyte counts of 100 000
cells/mm3 and 700 000 cells/mm3, respectively,
and the protein level was above 10 g/dL in both patients. Compound muscle
action potential amplitudes were reduced in some nerves with active denervation
in clinically affected muscles, and F-responses were absent but there were
no other demyelinating features. Magnetic resonance imaging showed discrete
T2-weighted signal changes of the ventral horns of the spinal cord, and one
had elevated coxsackievirus titers in the serum. There was little recovery
and significant atrophy in weak muscles after 3 years.
Conclusions The poliomyelitis syndrome still occurs in adults in developed countries.
It has superficial similarities to a motor axonal variant of Guillain-Barré
syndrome but can be distinguished by clinical, cerebrospinal fluid, and, perhaps
specifically, magnetic resonance imaging characteristics.
From the Neurology Service, St Elizabeth's Medical Center, Tufts University
School of Medicine, Boston, Mass.
Corresponding author: Kenneth C. Gorson, MD, Division of Neurology,
St Elizabeth's Medical Center, 736 Cambridge St, Boston, MA 02135 (e-mail:
KGorson{at}aol.com).
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