Between June 1988 to January 1991 a total of 246 children with
acute flaccid paralysis (AFP) were seen at Hospital Infantil de México, Federico Gómez which was the center of study for AFP for the
Poliomyelitis Eradication Program of Mexico. Of the 246 children, 42 has
poliomyelitis (17%); 156 has
Guillain-Barré syndrome (GBS) (63.4%); 16 had traumatic
neuritis of the sciatic nerve secondary to IM
injections (TNC) (6.5%); five had
transverse myelitis (2%); the rest (27) had other diseases misdiagnosed as
polio (10.9%). The basic clinical characteristics for the diagnosis of
poliomyelitis are: myalgias and
fever at the onset AFP,
paralysis is asymmetrical, of distal predominance and causes severe
muscular atrophy and skeletal
deformities; the GBS presents as an ascending, symmetrical, areflexic
paralysis of distal predominance. It does not causes
atrophy or
deformities. TNC presents several days after IM
injections with
pain and
hypothermia in the affected limbs; TM is a flaccid, symmetrical
paraparesis with
neurogenic bladder and a sensory level. CSF and neurophysiological studies (EMG and NCV) are very useful for diagnosis. Other entities misdiagnosed as
poliomyelitis were: osteoarticular
trauma,
myopathies and dystrophies, viral
myositis, acute cerebellitis, retroperitoneal
tumors and upper motor neuron syndromes. Viral studies in stool specimens are essential for the diagnosis of
poliomyelitis.