Polio physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Most patients with a normal immune system will be asymptomatic and will have a normal physical exam. 4 to 8% of patients may develop abortive poliomyelitis, that may only show fever on the physical exam. 1 to 2% of patients will manifest non-paralytic poliomyelitis, that may present with findings of nuchal rigidity, and positive Kernig's and Brudzinski's signs. Less than 1% of patients will have paralytic poliomyelitis. This form of the disease may be manifested as: spinal paralytic poliomyelitis or bulbar paralytic paralysis. The spinal form may present with: fever; meningeal signs; weakness of the extremities; and asymmetrical flaccid paralysis, most frequently of the lower limbs. The bulbar form may present with: pharyngeal paralysis, with accumulation of secretions, inability to swallow and sometimes respiratory arrest. When poliencephalitis occurs, seizures and spastic paralysis may be present.
Physical Examination
About 95% of patients with an healthy immune system are asymptomatic and have a normal physical examination.[1]
4 to 8% of poliovirus infection may lead abortive poliomyelitis, a mild symptomatic disease with little findings on physical exam. 2 to 3 days of fever may be the only finding.[2]
Poliovirus infection may cause non-paralytic (1-2%) or paralytic (<1%) forms of the disease. Physical findings in these forms of the disease may include:
Non-Paralytic Poliomyelitis
Meningeal signs may be present on physical exam:[2]
- Nuchal rigidity
- Positive Kernig's sign
- Positive Brudzinski's sign
Paralytic Poliomyelitis
Spinal Paralytic Poliomyelitis
Temperature
- A fever is often present
Extremities
- Weakness of the extremities, predominantly of the proximal muscles, is characteristic of this form of the disease. Lower extremities are more often involved.
- Asymmetrical flaccid paralysis, predominantly of the proximal muscles, is characteristic of this form of the disease. Lower extremities are more often involved.
Neurologic
- Meningeal signs may be present on physical exam, such as:[2]
- Initially hyperactive deep tendon reflexes, that later become absent.
- Common combinations of limb involvement include:
- One lower limb, followed by one upper limb
- Both lower limbs, followed by both upper limbs
- Quadriplegia is a rare finding in infants.
Bulbar Paralytic Poliomyelitis
Neurologic
- Pharyngeal paralysis, evidenced by accumulation of secretions is often present in this form of the disease.[2]
- Inability to swallow[2]
- In rare severe cases, respiratory centers may be affected, leading to inability to breathe.[2]
Polioencephalitis
Neurologic
- Seizures are often present
- Spastic paralysis may be present
References
- ↑ "Poliomyelitis".
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.