Polio physical examination: Difference between revisions
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===Paralytic Poliomyelitis=== | ===Paralytic Poliomyelitis=== | ||
====Spinal Paralytic Poliomyelitis==== | ====Spinal Paralytic Poliomyelitis==== | ||
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Frank paralysis occurs in roughly 0.1% of all poliovirus infections. A biphasic course with minor and major illnesses is observed in approxi- mately one third of children with paralytic poliomyelitis. The minor illness, coinciding with viremia, corresponds to the symptoms of abor- tive poliomyelitis and lasts 1 to 3 days. The patient appears to be recovering and remains symptom-free for 2 to 5 days before the abrupt onset of the major illness, which is heralded by symptoms and signs of meningitis, including fever, chills, headache, fever, malaise, vomit- ing, neck stiffness, and cerebrospinal fluid (CSF) pleocytosis. Adults usually experience a single phase of illness, with a prolonged prodrome of symptoms preceding the gradual onset of paralysis.28,29 The major illness begins with severe myalgias and occasionally localized cutane- ous hyperesthesia, paresthesias, involuntary muscle spasm, or muscular fasciculations. The meningismus and muscle pain are present for 1 to 2 days before frank weakness and paralysis ensue. The severity of the disease varies from weakness of a single portion of one muscle to complete quadriplegia. The paralysis is flaccid; deep tendon reflexes are initially hyperactive and then become absent. The most character- istic feature of the paralysis is its asymmetrical distribution, which affects some muscle groups while sparing others. Proximal muscles of the extremities tend to be more involved than distal muscles, the legs are more commonly involved than the arms, and the large muscle groups of the hand are at greater risk than the small ones. Any com- bination of limbs may be paralyzed, but the most common pattern is involvement of one leg, followed by one arm, or both legs and both arms. Quadriplegia is almost never observed in infants.29 Although occasional cases progress from the onset of weakness to complete quadriplegia and bulbar involvement in a few hours, more commonly the paralysis extends over 2 to 3 days. Progression of paralysis stops when the patient becomes afebrile.28 Paralysis of the bladder is usually associated with paralysis of the legs. It occurs in about 25% of adults but is uncommon in children. Sensory loss in poliomyelitis is very rare30 and its occurrence should strongly suggest some other diagnosis (e.g., Guillain-Barré syndrome). | |||
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====Bulbar Paralytic Poliomyelitis==== | ====Bulbar Paralytic Poliomyelitis==== | ||
Revision as of 03:42, 3 September 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Physical Examination
About 95% of patients with an healthy immune system are asymptomatic and have a normal physical examination.[1]
4 to 8% of poliovirus infection may lead abortive poliomyelitis, a mild symptomatic disease with little findings on physical exam. 2 to 3 days of fever may be the only finding.[2]
Poliovirus infection may cause non-paralytic (1-2%) or paralytic (<1%) forms of the disease. Physical findings in these forms of the disease may include:
Non-Paralytic Poliomyelitis
Meningeal signs may be present on physical exam, such as:[3]
Paralytic Poliomyelitis
Spinal Paralytic Poliomyelitis
Bulbar Paralytic Poliomyelitis
Polioencephalitis
References
- ↑ "Poliomyelitis".
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.