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Sudden onset of lower limb flaccid paralysis
  1. Francesca Seregni,
  2. Saraswathy Sabanathan,
  3. Justin Cross,
  4. Manali Chitre,
  5. Deepa Krishnakumar
  1. Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Dr Francesca Seregni, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; francesca.seregni{at}nhs.net

http://dx.doi.org/10.1136/archdischild-2018-315903

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    A previously well 15-year-old boy presented to the emergency department with sudden-onset severe back pain and inability to weight bear. Preceding this event, he stretched out in bed and felt a click in his back.

    On examination, he was alert and interactive with normal vital signs. Neurological examination of the lower limbs demonstrated bilateral hypotonia and reduced power to 2/5 proximally and distally, absent reflexes, sensory level at L2 with paraesthesia (pins and needles) and dysaesthesia bilaterally. Upper limbs, cranial nerves and general examination were unremarkable. His condition progressed with worsening lower limb weakness and urinary retention, without any respiratory compromise.

    Questions

    1. List three differential diagnoses for acute flaccid paralysis.

    2. An MRI of the spine was normal. On further assessment, the patient was noticed to have pale legs with prolonged capillary refill. The right posterior tibialis pulse was thready, and the left posterior tibialis and dorsalis …

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    Footnotes

    • Contributors FS drafted the article; SS, JC, MC and DK critically revised the article.

    • Competing interests None declared.

    • Patient consent Parental/guardian consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.