Zebras Seize the Day: Rare Causes of Status Epilepticus Across the Continuum of Critical Care

Status epilepticus (SE) is a common neurologic emergency and is associated with a high risk of morbidity and mortality. The management of SE in the intensive care unit centers on stabilization and treatment, as well as identifying and treating the underlying etiology. Numerous etiologies of SE are amenable to treatment, including certain genetic and metabolic disorders, autoimmune encephalitis and other inflammatory disorders, intracranial infections, and toxic/metabolic derangements. This article highlights rare but important causes of SE across the continuum of care from neonates to adults

Acute flaccid myelitis: cause, diagnosis, and management

Acute flaccid myelitis (AFM) is a disabling, polio-like illness mainly affecting children. Outbreaks of AFM have occurred across multiple global regions since 2012, and the disease appears to be caused by non-polio enterovirus infection, posing a major public health challenge. The clinical presentation of flaccid and often profound muscle weakness (which can invoke respiratory failure and other critical complications) can mimic several other acute neurological illnesses. There is no single sensitive and specific test for AFM, and the diagnosis relies on identification of several important clinical, neuroimaging, and cerebrospinal fluid characteristics. Following the acute phase of AFM, patients typically have substantial residual disability and unique long-term rehabilitation needs. In this Review we describe the epidemiology, clinical features, course, and outcomes of AFM to help to guide diagnosis, management, and rehabilitation. Future research directions include further studies evaluating host and pathogen factors, including investigations into genetic, viral, and immunological features of affected patients, host-virus interactions, and investigations of targeted therapeutic approaches to improve the long-term outcomes in this population