Polio is an ancient disease. Involvement of anterior horn cells due to viral infection is the pathological mechanism underlying this condition. It remains to be a clinical diagnosis because most of the time, stool cultures are negative for poliovirus. Recent advances in magnetic resonance imaging may be helpful in establishing a definite diagnosis of poliomyelitis in addition to a clinical picture consistent with polio.
A 28-year-old man was admitted to the hospital with a 4-day history of progressive weakness and low-grade fever. His neurological examination revealed normal mental status and cranial nerves, flaccid weakness of both lower extremities and left upper extremity, absent reflexes, flexor plantar responses, and normal sensory examination results. Cerebrospinal fluid examination findings showed 28 cells, predominantly lymphocytes, and normal glucose and protein levels. The patient had no history of polio vaccination, but his 6-month-old daughter was recently vaccinated with an oral polio vaccine. Results from a nerve conduction examination and electromyography were normal. T2-weighted magnetic resonance imaging showed hyperintensities involving bilateral anterior horn cells (Figure 1 and Figure 2).
T2-weighted magnetic resonance image of cervical spine in sagittal plane showing hyperintense signal involving anterior horn cells extending from C3 through C7 (arrow).
T2-weighted magnetic resonance image of cervical spine in axial plane showing hyperintense signal involving anterior horn cells (arrow). Inset, the level of this axial section.
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