1. Poliomyelitis Electrodiagnosis
Dr Mohamed ibrahim khalil
physical medicine Rheumatology and rehabilitation ,
Alexandria University EGYPT
To contact Dr M. Ibrahim
Reverie-forever@hotmail.com

2. History
A 1.5 year-old child named Abdel-Rahman Ali
Basiouny presented with weakness of left upper
and lower limb and inability to walk of 2 days
duration

3. • The condition started 20 days ago with
acute onset of high fever (39 C ) and
common cold which Resolved on medical
tratment
• A week later the high fever recurred and
associated with Acute severe weakness of
left upper and lower limbs and inability to
walk

4. After three days the fever resolved on
medical treatment while the weakness
Persists ( The weakness was maximum
from the start )
** MRI Brain was done which revealed normal
findings .
The patient then refered to do electrophysiological
study .

5. •
•
•
•
•
No history of similar attacks
No history of head trauma
No history of change of consciousness
No history of convulsions
NO history of involuntary movements

6. • Past Medical History : Irrelvant
• Family History : Irrelevant
• Vital signs :
Pulse 95 b/min
Respiration 16 /min
Blood Pressure 125/90
Temperature 37 C

7. Physical examination
1- Mental or intellectual function:
• The Patient is fully conscious, alert
oriented
2- Speech and articulation : Normal
3- Cranial nerves : Free

8. 4- Sensory examination : intact
5- Gait : inability to walk
6- Motor examination :
• Muscle state : Normal
• Muscle Tone :HYPOTONIA on Left upper
and lower Limbs
• No involuntary movements
• No fasiculations

9. Muscle Power
examination :
P
ower examination of
muscles on the right
side of the body is
completely normal ( G 5
)

10. Muscle Power
examination :
Most of the
muscles on the
left side of the
body is affected
except :
Wrist flexors G5
Planter flexor G 5
Triceps
G5

11. Power
examination
:
• Inability to raise arm
( Deltoid Grade ZERO )

12. Power
examination
:
• Moderate Left hip
flexion ( G 3 )
• Inability to
extend the left
Knee extension
(quadriceps G 0 )

13. Muscle Power
examination :
•
•
•
•
•
•
•
Biceps : G 3
Wrist extensors G 2
Hand muscles : G 3
Hip flexors : G 4
Hip extensors : G 3
Hamestrings : G 3
Dorsiflexors : G 4

14. Reflexes
examination
:
Right side reflexes : Normal
Left side reflexes :
• Abscent Knee reflex
• Present ankle reflex
• Abscent biceps reflex
Negative extensor planter sign

15. Reflexes
examination
Pathological Reflexes :
• Flexor planter
:

16. Differential diagnosis
1.
2.
3.
4.
5.
Guillian Barre Syndrome
Encephalitis
Menengitis
Poliomyelitis
Polio-Like

29. Right
Left
Median
6.3
3.2
Axillary
1.83
0.6
Femoral
1.97
0.63
Posterior
tibial
11.7
11.3
Deep
peroneal
7.5
Ulnar
4..6

30. Diagnosis
• Multiple Patchy Axonopathic LMNL Suggestive of

32. Where is Polio present
TODAY
• In 2008, only four countries in the world remain with
polio-endemic, down from more than 125 in 1988.
The remaining countries are Afghanistan, India,
Nigeria and Pakistan.
12/15/13
Dr.T.V.Rao MD
32

43. Polio – like syndromes
• patients with suspected poliomyelitis, but
from whom poliovirus was not isolated, a
variety of causes of the paralysis was
found.

44. • Enterovirus infections, especially
coxsackieviruses A9 and A23 (echovirus 9) and
group B coxsackieviruses, frequently caused
meningoencephalitis often associated with
transient paralysis. Coxsackievirus A7 infection
occasionally resulted in permanent paralysis.
• Exotic causes included paralysis due to snake
bite, spider bite, scorpion sting, and tick bite and
schistosomiasis involving the spinal cord

45. • Chemical poisons, such as arsenic,
triorthocresyl phosphate, and
organophosphorus insecticides,
• Paralysis in individual patients with
porphyria followed the administration of
anesthesia and certain drugs.

46. • The Guillain-Barré syndrome in some
patients resulted from virus infection of the
nerve tissue, in others it was related to a
hyperreactive autoallergic state.
• Injury of the spinal column sometimes
followed by periostitis or osteomyelitis was
relatively common.

47. 12/15/13
Dr.T.V.Rao MD
47