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A 12 year old boy with a history of ADHD on Adderall comes in for acute onset weakness of his bilateral upper arms, particularly on the right side. He had a viral URI 1 week ago with fever, cough, congestion, sore throat, from which he had recovered. For the past week, he did not take the Adderall because he had been sick and “forgot” to resume. On physical exam, his right arm is flaccid and motionless at his side, and he is unable to use it at all. He is able to lift his left arm partly against gravity, but it is weak. He has a low-grade fever of 38, and mild neck stiffness. His mental status is normal.
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November 9, 2018 at 6:55 pm
A) A virus, specifically Enterovirus D68. Several outbreaks of acute flaccid paralysis due to Enterovirus 68 have been reported in children across the USA. Median age of onset is 9 years, and the majority have had a recent URI (on average 7 days prior). Children present with neurologic symptoms, particularly weakness in proximal extremities, and can have fever, neck stiffness, headache, and cranial nerve abnormalities. Diagnosis is by MRI, and although immunomodulatory agents have been used, treatment is mainly supportive. Recovery is usually partial with persistent neurologic deficits.