Differential Diagnosis of Acute Flaccid Paralysis

Poliomyel s Guillain‐Barré Trauma c neuri s Acute Childhood Transverse

Installa on of 24 to 48 hours onset to Hours to ten days Hours to four days Hours to 1‐2 days and Hours to four days
paralysis full paralysis (acute‐sub acute) (acute) some mes > 3 days + pain
(acute) (acute) (acute)

Fever at onset High, always present at Not common Commonly present High and accompanied Rarely present
onset of flaccid paralysis, before, during and by convulsion
gone the following day a er flaccid paralysis

Flaccid paralysis Acute, usually Generally acute, Asymmetrical, acute Asymmetrical‐ Acute, lower
asymmetrical, principally symmetrical and and affec ng only hemiplegia more limbs,
proximal distal one limb common on right symmetrical
Muscle tone Reduced or absent in Global hypotonia reduced or absent in Reduced in affected hypotonia in
affected limb affected limb limbs lower limbs
Deep‐tendon Decreased to absent Globally absent Decreased to absent Decreased in Absent in lower
reflexes hemiplegic limbs early limbs early &
& hyper reflexia late hyper reflexia late

Sensa on Severe myalgia, backache, Cramps, ngling, Pain in gluteus, Decreased in affected anesthesia of
no sensory changes hypoanaesthesia of hypothermia limbs lower limbs with
palms and soles sensory level
Cranial nerve Only when bulbar O en present, Absent Facial nerve (VII) Absent
involvement involvement is present affec ng nerves VII,
IX, X, XI, XII
Respiratory Only when bulbar In severe cases, Absent Absent Some mes
insufficiency involvement is present enhanced by
bacterial pneumonia
Autonomic Rare Frequent blood Hypothermia in Absent Present
signs & pressure altera ons, affected limb
symptoms swea ng, blushing
and body
temperature
fluctua ons
Cerebro‐spinal Inflammatory Albumin‐cytologic Normal Depends on ae ology: Normal or mild
fluid dissocia on infec ous or vascular increase in
inflammatory cells
Bladder Absent Transient None None Present
dysfunc on
Nerve Abnormal: anterior horn Abnormal: slowed Abnormal: axonal Normal normal or
conduc on cell disease (normal conduc on, damage abnormal, no
velocity: third during the first 2 weeks) decreased motor diagnos c value
week amplitudes
EMG at three Abnormal Normal Normal Normal normal
weeks

Sequelae at Severe, asymmetrical Symmetrical atrophy Moderate atrophy, Moderate atrophy Flaccid diplegia
three months atrophy, skeletal of distal muscles only in affected limb atrophy a er
and up to a deformi es developing years
year later

AFP SURVEILLANCE
AFP SURVEILLANCE
for polio-free Pakistan
for polio-free Pakistan