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Assessment of acute motor deficit in the pediatric emergency room
Marcio Moacyr Vasconcelos1, Luciana G A Vasconcelos2, Adriana Rocha Brito1
1Universidade Federal Fluminense (UFF), Hospital Universitário Antônio Pedro, Departamento Materno Infantil, Niterói, RJ, Brazil.
Insights
This review outlines diagnostic strategies for acute-onset muscle weakness in pediatric emergency patients. A thorough history and physical exam are crucial for accurate diagnosis and management of pediatric weakness.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Clinical Diagnostics
Background:
- Acute motor deficit is a common pediatric emergency room presentation.
- Differentiating causes of acute weakness is essential for timely intervention.
- Common etiologies include Guillain-Barré syndrome and transverse myelitis.
Purpose of the Study:
- To present a clinical approach for diagnosing acute-onset muscle weakness in children and adolescents.
- To emphasize diagnostic investigation in the emergency room setting.
- To provide algorithms for investigating localized or diffuse weakness.
Main Methods:
- Systematic literature search of PubMed (April-May 2017).
- Keywords included "acute," "weakness," "child," "pediatric," and "emergency."
- Review focused on articles published between 1997-2017 for ages 0-18.
Main Results:
- Acute motor deficit can be localized or diffuse, requiring precise clinical description.
- Differential diagnosis includes various neurological and neuromuscular conditions.
- Algorithms are presented for emergency room diagnostic workup.
Conclusions:
- Clinical skills in history taking and physical examination are paramount.
- An organized, stepwise diagnostic approach is essential.
- Effective management aims to restore patient well-being and health.
Objectives:
This review article aimed to present a clinical approach, emphasizing the diagnostic investigation, to children and adolescents who present in the emergency room with acute-onset muscle weakness.
Sources:
A systematic search was performed in PubMed database during April and May 2017, using the following search terms in various combinations: "acute," "weakness," "motor deficit," "flaccid paralysis," "child," "pediatric," and "emergency". The articles chosen for this review were published over the past ten years, from 1997 through 2017. This study assessed the pediatric age range, from 0 to 18 years.
Summary Of The Data:
Acute motor deficit is a fairly common presentation in the pediatric emergency room. Patients may be categorized as having localized or diffuse motor impairment, and a precise description of clinical features is essential in order to allow a complete differential diagnosis. The two most common causes of acute flaccid paralysis in the pediatric emergency room are Guillain-Barré syndrome and transverse myelitis; notwithstanding, other etiologies should be considered, such as acute disseminated encephalomyelitis, infectious myelitis, myasthenia gravis, stroke, alternating hemiplegia of childhood, periodic paralyses, brainstem encephalitis, and functional muscle weakness. Algorithms for acute localized or diffuse weakness investigation in the emergency setting are also presented.
Conclusions:
The clinical skills to obtain a complete history and to perform a detailed physical examination are emphasized. An organized, logical, and stepwise diagnostic and therapeutic management is essential to eventually restore patient's well-being and full health.
