Acute Poliomyelitis Workup

  • Author: Christine Weiler, MD; Chief Editor: Denise I Campagnolo, MD, MS   more...
 
Updated: Jan 18, 2012
 

Laboratory Studies

  • Order lumbar puncture test.
    • Cerebrospinal fluid (CSF) pressure may be increased.
    • Pleocytosis (neutrophils in the first few days, then lymphocytes) may be noted in the CSF during the period before onset of paralysis in acute poliomyelitis.
    • The CSF protein content may be elevated slightly with a normal glucose, except in patients with severe paralysis, who may demonstrate protein elevations to 100-300 mg/dL for several weeks.
  • Order a complete blood count (CBC), because leukocytosis may be present.
  • Perform virus recovery from throat washing, stool culture, blood culture, and CSF culture. Viral studies in stool specimens are essential for the diagnosis of poliomyelitis.
    • Recover virus from throat washing during the first week and stool culture from the first 2-5 weeks.
    • In rare cases, the virus may be isolated from CSF or serum, in contrast to the paralytic illnesses caused by other enteroviruses.
    • These tests require additional demonstration of a 4-fold rise in the virus antibody titer to make a specific diagnosis.
  • Polymerase chain reaction is routinely used to differentiate wild-type strains from vaccine strains.
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Imaging Studies

  • Magnetic resonance imaging (MRI) may show localization of inflammation to the spinal cord anterior horns.
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Procedures

  • Electromyography
    • The earliest electromyographic finding in poliomyelitis is a reduction in the recruitment pattern and a diminished interference pattern due to acute motor axon fiber involvement.
    • Fibrillations develop in 2-4 weeks and persist indefinitely; fasciculations also may be observed.
    • Motor unit action potentials initially have decreased amplitude and then become large in amplitude with increased duration. Later, polyphasic motor units are observed because of nerve reinnervation.
    • The motor nerve conduction velocities remain within normal limits; however, the compound muscle action potential (CMAP) is reduced in direct proportion to the number of motor axons that are affected. Sensory nerve conduction studies remain within normal parameters, due to sparing of the dorsal root ganglion.
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Histologic Findings

Under microscopy, the spinal anterior horn cells are surrounded by inflammatory cells. Spongiosis of the gray matter, containing many scattered inflammatory cells, also is noted. Most inflammatory cells are neutrophil leukocytes.

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Contributor Information and Disclosures
Author

Christine Weiler, MD  Staff Physician, Department of Physical Medicine and Rehabilitation, University of Colorado Health Sciences Center

Christine Weiler, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, Association of Academic Physiatrists, and Colorado Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Selina Yingqi Xing, MD, MS  Staff Physician, Department of Physical Medicine and Rehabilitation, Temple University

Selina Yingqi Xing, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Harry Schwartz, MD  Director of Medical Rehabilitation Program & Spinal Cord Injury Program, Moss Rehabilitation Hospital; Clinical Assistant Professor, Department of Physical Medicine and Rehabilitation, Temple University School of Medicine

Harry Schwartz, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Congress of Rehabilitation Medicine, American Medical Association, American Paraplegia Society, American Spinal Injury Association, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Milton J Klein, DO, MBA  Consulting Physiatrist, Heritage Valley Health System-Sewickley Hospital and Ohio Valley General Hospital

Milton J Klein, DO, MBA is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Medical Acupuncture, American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, American Pain Society, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Kat Kolaski, MD  Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine

Kat Kolaski, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Denise I Campagnolo, MD, MS  Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers

Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers

Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching; Genzyme Corporation Grant/research funds investigator; Biogen Idec Grant/research funds investigator; Genentech, Inc Grant/research funds investigator; Eli Lilly & Company Grant/research funds investigator; Novartis investigator; MSDx LLC Grant/research funds investigator; BioMS Technology Corp Grant/research funds investigator; Avanir Pharmaceuticals Grant/research funds investigator

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