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Nonpoliovirus poliomyelitis simulating Guillain-Barré syndrome.

K C Gorson1, A H Ropper

  • 1Division of Neurology, St Elizabeth's Medical Center, 736 Cambridge St, Boston, MA 02135, USA. KGorson@aol.com

Archives of Neurology
|September 18, 2001
PubMed
Summary

Nonpoliovirus poliomyelitis still occurs in adults, presenting with limb weakness and resembling Guillain-Barré syndrome. Spinal cord MRI findings can help distinguish these cases from Guillain-Barré syndrome variants.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Wild-type poliovirus is eradicated in the US due to vaccination.
  • Nonpoliovirus poliomyelitis, often caused by enteroviruses like coxsackievirus or echovirus, remains a concern.
  • This condition can mimic Guillain-Barré syndrome, a neurological disorder affecting the peripheral nervous system.

Observation:

  • Two adult patients presented with progressive, asymmetrical limb weakness and respiratory failure following a viral illness.
  • Clinical and cerebrospinal fluid findings included fever, reduced reflexes, high mononuclear cell counts, and elevated protein levels.
  • Electrophysiological studies indicated denervation without demyelination, and spinal cord MRI revealed ventral horn signal changes.

Findings:

  • Magnetic resonance imaging (MRI) of the spinal cord showed discrete T2-weighted signal changes in the ventral horns.

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  • Cerebrospinal fluid analysis revealed elevated mononuclear leukocytes and protein levels.
  • Elevated coxsackievirus titers were noted in one patient, suggesting an enteroviral cause.

    • Implications:

    • Nonpoliovirus poliomyelitis can occur in adults and presents with symptoms similar to Guillain-Barré syndrome variants.
    • Distinguishing between these conditions is crucial for appropriate diagnosis and management.
    • Spinal cord MRI characteristics, alongside clinical and CSF findings, may aid in differentiating nonpoliovirus poliomyelitis from Guillain-Barré syndrome.