Purpose or Case Report: Introduction: Acute flaccid myelitis (AFM) is a relatively new subcategory of acute flaccid paralysis affecting children, which has gained increasing attention in the medical community and media in recent years. AFM is characterized by rapid onset acute flaccid limb weakness with spinal cord lesions on magnetic resonance imaging (MRI) predominantly involving the gray matter. Cranial nerve involvement has also been described. The severity of AFM nearly always requires hospitalization for supportive care, which may include mechanical ventilation. Evidence is lacking regarding the utility of specific therapies, although patients have been treated with intravenous immune globulin, steroids, and antiviral therapy. Unfortunately, though neurological improvement may occur, the majority of patients are left with persistent deficits.

We present the imaging findings of three children with varying presentations and outcomes of acute flaccid myelitis treated at a tertiary care children’s hospital.

Case 1: An 11-year-old girl developed severe upper extremity weakness requiring weeks of inpatient rehabilitation with plan for evaluation for nerve transfer. MRI showed abnormal increased T2 signal of nearly the entire spinal cord, most notable in the cervical spinal cord.

Case 2: A 9-year-old boy positive for Enterovirus presented with bilateral upper and lower extremity weakness, whose symptoms ultimately resolved. MRI of the brain and full spine were normal except for a thoracic spinal cord syrinx, which was felt to be incidental.

Case 3: A 2-year-old girl with a history of acute lymphoblastic leukemia developed bilateral upper extremity weakness and lower extremity areflexia during a hospitalization for an acute viral illness, complicated by chronic ventilator-dependent respiratory failure. MRI demonstrated enhancing T2 signal in the brainstem and cervical and thoracic spinal cord.

Discussion: Acute flaccid myelitis is an important pediatric neurological disorder of rapid clinical onset frequently resulting in persistent neurological deficits. Radiologists serve an important role in establishing the diagnosis by identifying this disease’s characteristic MRI findings.
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