Acute flaccid paralysis

Differential Diagnosis

	Guillain-Barré syndrome	Paralytic poliomyelitis
Fever	afebrile	febrile with myalgias
Progression	subacute, days to weeks	acute, peaks at 2-4 days
Neurological deficits	ascending, symmetric muscle weakness with decreased DTRs	asymmetric weakness with increased DTRs; proximal more than distal, and legs more than arms
Sensory changes	mild disturbances or paresthesias	none
CSF findings	minimal or no pleocytosis, but elevated protein (albuminocytologic dissociation)	pleocytosis with elevated protein, normal glucose (aseptic meningitis)

• Infection
  • Viral
    • Picornaviridae
      • Enterovirus 71
      • Enterovirus D68
      • Coxsackievirus A7
      • Poliovirus
    • Flaviviridae: West Nile virus, Japanese encephalitis, Tick-borne encephalitis
    • Herpesviridae: CMV, EBV, VZV
    • HIV-related opportunistic infections
    • Rabies
  • Bacteria
    • Borrelia burgdorferi
    • Corynebacterium diphtheriae
    • Clostridium botulinum
    • Mycoplasma pneumoniae
• Neuropathy
  • Guillain-Barré syndrome, though it is typically symmetrical and bilateral ascending paralysis that may include loss of sensation
  • Acute motor axonal neuropathy
  • Critical illness neuropathy
  • Lead poisoning
  • Other heavy metal poisoning
• Spinal cord
  • Acute transverse myelitis
  • Acute spinal cord compression
  • Trauma
  • Infection
• Neuromuscular junction
  • Myasthenia gravis
• Muscle
  • Polymyositis
  • Viral myositis
  • Post-infectious myositis
  • Critical illness myopathy
• Functional