Enterovirus 71-induced acute flaccid paralysis: two case reports with review of literatures

Abstract

Objective To investigate the clinical characteristics and prognosis of hand⁃foot⁃and⁃mouth disease (HFMD) complicated with acute flaccid paralysis (AFP). Methods The clinical features, MRI, electroencephalogram (EEG), neurophysiological examination and prognosis of 2 cases of HFMD complicated with AFP were analyzed retrospectively. Functional recovery was followed up for 9 weeks. Related literatures were reviewed. Results Both of the two cases are infants. AFP occurred at the 7 th day, and advanced to severe degree at 1-2 d after onset. Paralysis affected one limb in one case and 3 limbs in another case. Muscle strength ranged from 0 to 3 degree. Cranial MRI indicated broadened extracerebral lacuna. Cervical MRI presented long T2 lesion in the spinal cord. EEG recorded symmetrical slow background waves. Neurophysiological examination showed minor or moderate spontaneous potential at the paralytic limb. The duration of motor unit potential was prolonged, but the amplitude declined. Motor nerve conduction velocity was normal. Terminal latent period was intact. The amplitude of muscle motor potential declined. Sensory nerve conduction velocity was normal. F wave disappeared. Both of the 2 patients began to recover 2-3 weeks later. Conclusion HFMD complicated with AFP usually affects infant. Paralysis usually occurs around 1 week during the course of HFMD and progresses rapidly to peak 1-2 days after onset. Unique or multi limbs can be affected and the paralysis can recover rapidly. MRI, EEG, and neurophysiological examination are valuable for diagnosis and predicting prognosis. DOI：10.3969/j.issn.1672-6731.2011.06.01