Diagnosis:
A combination of clinical features and CSF analysis
Clinical features:
Prodrome: upper respiratory tract infection
Followed by:
- Mild meningismus +headache
- Myalgial, paraesthesia, paralysis and respiratory weakness
- After recovery LMN features and flaccid weakness. Autonomic features (swollen, clammy, cold, purple) in Lower limbs.
Findings in Investigations:
CSF:
- Pleocytosis
Serology
NCS/EMG:
- Asymmetrical involvement. Motor evoked potential MEP: reduced on affected side.
- Spontaneous Activity: Fibrillation potentials, Positive waves
- Motor distal conduction latency: normal
- F-waves: normal
- Sensory conduction: normal
Pathology:
Anterior horn cells: Cowdry B inclusions (small, no halo),
Post-Polio syndrome:
Clinical features:
- History of Poliomyelitis
- New LMN weakness ~30-40 years afterwards