ABSTRACT
Brazil is the fourth largest exporter of pork worldwide, with its production concentrated in the Southern region of the country. To reduce the economic impacts and increase herd health, an efficient diagnosis of diseases is necessary. The frequency, seasonal, and annual distribution of diseases that affecting the swine nervous system in Southern Brazil were determined through a retrospective study conducted from 2008 to 2018. A total of 231 pigs were evaluated, and distributed in the following phases: suckling piglets, nursery, growing, finishing, and adults. Piglets in the nursery phase were the most affected with 58.01%. Infectious diseases accounted for 87.01% (201/231) of lesions in the nervous system. Bacterial meningitis was observed in 58.87% of cases, presenting an endemic distribution, and a propensity to occur in the months of autumn/winter. The highest number of cases of porcine circovirus-2 were observed in 2008 and 2009, with a subsequent decline. Porcine circovirus, salt poisoning, and brain abscesses exhibited no association between the seasonal occurrence and annual distribution. Salt poisoning was observed more frequently in the last years of this study. Both, non-suppurative encephalomyelitis and selenium toxicosis exhibited an association between their occurrence and seasonal distribution in, the months of winter, and summer, respectively.(AU)
Brasil é o quarto maior exportador de carne suína do mundo, com sua produção concentrada na região Sul do país. Para reduzir os impactos econômicos e aumentar a saúde do rebanho, é necessário o diagnóstico eficiente das doenças. A frequência, distribuição sazonal e anual das doenças que afetam o sistema nervoso de suínos no Sul do Brasil foram determinadas através de um estudo retrospectivo no período de 2008 a 2018. Foram avaliados 231 suínos, distribuídos nas seguintes fases: maternidade, creche, crescimento, terminação e adultos. Leitões da fase de creche foram os mais afetados com 58,01%. As doenças de origem infecciosa foram responsáveis por 87,01% (201/231) das causas de lesões no sistema nervoso. Meningite bacteriana foi observada em 58,87% dos casos, apresentando distribuição endêmica, e uma tendência a ocorrer nos meses de outono/inverno. O maior número de casos de circovírus suíno foram observados em 2008 e 2009, com declínio posterior. Circovírus suíno, intoxicação por sal e os abscessos encefálicos não apresentaram associação entre a ocorrência sazonal e distribuição anual. A intoxicação por sal foi observada com maior frequência nos últimos anos deste estudo. A encefalomielite não supurativa e a intoxicação por selênio exibiram associação entre a sua ocorrência e distribuição sazonal, nos meses de inverno e verão, respectivamente.(AU)
Subject(s)
Animals , Swine , Central Nervous System Diseases/veterinary , Meningitis , EncephalomyelitisSubject(s)
Humans , Male , Aged, 80 and over , Magnetic Resonance Imaging/methods , Encephalomyelitis/diagnostic imaging , Brain Stem/pathology , Brain Stem/diagnostic imaging , Chronic Disease , Adrenal Cortex Hormones/therapeutic use , Diagnosis, Differential , Encephalomyelitis/pathology , Encephalomyelitis/drug therapy , Glymphatic System/diagnostic imagingABSTRACT
Guillain-Barré syndrome (GBS) and acute disseminated encephalomyelitis (ADEM) are demyelinating neurologic disorders with different target organs. Although they share similar pathogenetic mechanism, reports of simultaneous occurrence of the 2 disorders are rare. A 2 year 6 month old girl visited our hospital for fever, cough, and general weakness. Although the muscle power of extremities showed mild weakness and voiding difficulty, initial deep tendon reflex of both knees and ankles was normal. A nerve conduction study to evaluate the weakness revealed the absence of F waves. Cerebrospinal fluid analysis demonstrated pleocytosis with lymphocyte predominance and elevated protein levels. Magnetic resonance imaging showed abnormal T2 hyperintensity in pons, medulla and spinal cord. Serum anti-GD1b antibody was positive. Based on clinical findings, laboratory findings, nerve conduction study, and neuroimaging, the diagnosis of GBS and ADEM was made. This is the first case of GBS accompanied by ADEM in Korea.
Subject(s)
Female , Humans , Ankle , Cerebrospinal Fluid , Cough , Demyelinating Diseases , Diagnosis , Encephalomyelitis , Encephalomyelitis, Acute Disseminated , Extremities , Fever , Guillain-Barre Syndrome , Knee , Korea , Leukocytosis , Lymphocytes , Magnetic Resonance Imaging , Nervous System Diseases , Neural Conduction , Neuroimaging , Peripheral Nervous System , Pons , Reflex, Stretch , Spinal CordABSTRACT
Se presenta un caso de Encephalomyelitis disseminata a la toma y el análisis del caso de acuerdo con la metodología de Clemens von Boenninghausen, considerando también las particularidades de los síntomas "genio", de las polaridades de los síntomas y los avances hechos por Boenninghausen en el tratamiento de los miasmas crónicos.
Subject(s)
Humans , Homeopathic Anamnesis , Repertory, Boenninghausen , EncephalomyelitisABSTRACT
Serum samples from 116 horses and 47 dogs from the municipality of Paulicéia, in the state of São Paulo, Brazil, were examined for anti-Toxoplasma gondii, -Neospora spp. and -Sarcocystis neurona antibodies by means of the indirect fluorescent antibody test (IFAT). The results showed that only one horse was seropositive for T. gondii (0.9%) and anti-Neospora spp. antibodies were detected in three out of the 116 horses tested (2.6%). However, 27 horses showed antibodies against S. neurona (23.8%). Amongst the serum samples from the dogs, 10 out of the 47 dogs showed antibodies against T. gondii (21.3%) and three dogs showed antibodies against Neospora caninum (6.4%). This study reports that in the municipality of Paulicéia dogs in both the rural and the urban area were exposed to T. gondii and N. caninum, while horses in the rural area were exposed to all three protozoa studied, with high occurrence of anti-S. neurona antibodies.(AU)
Amostras de soro de 116 equinos e 47 cães provenientes do município de Paulicéia, São Paulo, foram testadas para detecção de anticorpos anti-Toxoplasma gondii, -Neospora spp. e -Sarcocystis neurona por meio da reação de imunofluorescência indireta (RIFI). Apenas um equino, entre 116 equinos testados, teve diagnóstico soropositivo para T. gondii (0,9%), e três deles (2,6%) apresentaram anticorpos anti-Neospora spp. Entretanto, 27 equinos apresentaram anticorpos anti-S. neurona (23,8%). Nas amostras de cães, dez dos 47 animais apresentaram anticorpos anti-T. gondii (21,3%) e três tiveram diagnóstico soropositivo para Neospora caninum (6,4%). Este estudo relata que no município de Paulicéia os cães das áreas urbana e rural foram expostos a T. gondii e N. caninum, enquanto os equinos da área rural foram expostos aos três protozoários estudados, com alta ocorrência de anticorpos anti- S. neurona.(AU)
Subject(s)
Animals , Dogs , Horses , Neospora/immunology , Sarcocystis/immunology , Toxoplasma/immunology , Antigens, Protozoan , Brazil/epidemiology , Encephalomyelitis/diagnosis , Fluorescent Antibody Technique, Indirect/veterinary , Toxoplasmosis, Animal/epidemiologyABSTRACT
The proton magnetic resonance spectroscopy (¹H-MRS) is a tool used to detect concentrations of brain metabolites such as N-acetyl aspartate, choline, creatine, glutamate, and gamma-amino butyric acid (GABA). It has been widely used because it does not require additional devices other than the conventional magnetic resonance scanner and coils. Demyelination, or the neuronal damage due to loss of myelin sheath, is one of the common pathologic processes in many diseases including multiple sclerosis, leukodystrophy, encephalomyelitis, and other forms of autoimmune diseases. Rodent models mimicking human demyelinating diseases have been induced by using virus (e.g., Theiler's murine encephalomyelitis virus) or toxins (e.g., cuprizon or lysophosphatidyl choline). This review is an overview of the MRS findings on brain metabolites in demyelination with a specific focus on rodent models.
Subject(s)
Animals , Humans , Aspartic Acid , Autoimmune Diseases , Brain , Butyric Acid , Choline , Creatine , Demyelinating Diseases , Encephalomyelitis , Glutamic Acid , Models, Animal , Multiple Sclerosis , Myelin Sheath , Neurons , Pathologic Processes , Proton Magnetic Resonance Spectroscopy , Rodentia , Spectrum AnalysisABSTRACT
We present a case of 32-year-old male with profound mental retardation and autism spectrum disorder who had presented with seizures, rigidity and elevated creatine kinase and was initially diagnosed as neuroleptic malignant syndrome (NMS). The patient subsequently had a complicated clinical course, developing refractory status epilepticus, which lead to the eventual diagnosis of progressive encephalomyelitis with rigidity and myoclonus (PERM). We discuss the clinical similarities and differences between NMS and PERM, and highlight the need to consider alternative diagnoses when the clinical picture of NMS is atypical, particularly in this patient group where the history and clinical examination may be challenging.
Subject(s)
Adult , Humans , Male , Autism Spectrum Disorder , Autistic Disorder , Creatine Kinase , Diagnosis , Encephalomyelitis , Intellectual Disability , Myoclonus , Neuroleptic Malignant Syndrome , Seizures , Status EpilepticusABSTRACT
Four thoroughbred horses showing lameness, ataxia, circling, depression, recumbency, and seizures, were examined. The horses had gross, pale- to dark-red manifestations and foci in the central nervous system (CNS). Multifocal to coalescing eosinophilic necrotizing encephalomyelitis was observed histologically in the CNS along with intact or degenerated nematodes. Nematodes had polymyarian-coelomyarian musculature, a smooth thin cuticle, and intestines lined by multinucleated cells with microvilli. These traits suggested the nematodes belonged to the family Protostrongylidae, which includes Parelaphostrongylus tenuis. It was concluded that the horses were infected by nematodes, presumably Parelaphostrongylus tenuis, resulting in eosinophilic necrotizing encephalomyelitis.
Subject(s)
Humans , Ataxia , Central Nervous System , Depression , Encephalomyelitis , Eosinophils , Horses , Intestines , Microvilli , Parasites , SeizuresABSTRACT
The aim of this study was to examine the intra-uterine exposure to Sarcocystis spp. antigens, determining the number of foals with detectable concentrations of antibodies against these agents in the serum, before colostrum ingestion and collect data about exposure of horses to the parasite. Serum samples were collected from 195 thoroughbred mares and their newborns in two farms from southern Brazil. Parasite specific antibody responses to Sarcocystis antigens were detected using the indirect immunofluorescent antibody test (IFAT) and immunoblot analysis. In 84.1% (159/189) of the pregnant mares and in 7.4% (14/189) of foals we detected antibodies anti-Sarcocystis spp. by IFAT. All samples seropositive from foals were also positive in their respective mares. Serum samples of seropositive foals by IFAT, showed no reactivity on the immunoblot, having as antigens S. neurona merozoites. In conclusion, the intra-uterine exposure to Sarcocystis spp. antigens in horses was demonstrated, with occurrence not only in mares, but also in their foals, before colostrum ingestion these occurrences were reduced.
O objetivo deste estudo foi avaliar a exposição intrauterina ao Sarcocystis spp., para determinar o número de potros que possuem concentrações detectáveis de anticorpos contra esses agentes no soro, antes da ingestão do colostro, por meio da coleta de dados sobre a exposição a esses protozoários nos equinos. Amostras de soro foram coletadas de 195 éguas puro-sangue e seus respectivos potros recém-nascidos, em duas fazendas localizadas na região Sul do Brasil. Os testes utilizados na detecção de anticorpos específicos para o Sarcocystis foram a reação de imunofluorescência indireta (RIFI) e análise por meio de immunoblot. Pela RIFI, em 84,1% (159/189) das éguas e em 7,4% (14/189) dos potros foram detectados anticorpos anti-Sarcocystis spp. Todas as amostras soropositivas dos potros também foram positivas para suas respectivas mães. As amostras de soro dos potros soropositivos na RIFI, não apresentaram reatividade no immunoblot, tendo como antígenos merozoítos de S. neurona. Em conclusão, foi demonstrada a exposição intrauterina de Sarcocystis spp. em equinos, com ocorrência em éguas, porém, em seus respectivos potros, antes da ingestão de colostro a ocorrência foi reduzida.
Subject(s)
Animals , Antibodies, Protozoan/analysis , Horses/parasitology , Prenatal Diagnosis/veterinary , Sarcocystis/pathogenicity , Encephalomyelitis/veterinary , Immunoblotting , Immunoblotting/veterinary , Maternal-Fetal Exchange , Seroepidemiologic StudiesABSTRACT
Zika virus (ZIKV) is an arthropod-borne member of the genus Flavivirus, closely related to the dengue, West Nile, Japanese encephalitis, and yellow fever viruses and is transmitted by Aedes spp. mosquitoes. It has emerged explosively since 2007 to cause a series of epidemics in Micronesia, the South Pacific, and most recently the Americas. Following the first detection of ZIKV on the American continent, autochthonous ZIKV transmission has been confirmed throughout Central and South America. The unprecedented numbers of people infected during recent outbreaks in the South Pacific and the Americas may have resulted in enough ZIKV infections to notice patterns of the associated incidence of congenital microcephaly, Gillain-Barre symdrome, and acute diffuse encephalomyelitis. Here we review the history, emergence, biology, transmission, and control strategies for the ongoing outbreak through vector-centric approaches on ZIKV to date.
Subject(s)
Aedes , Americas , Arboviruses , Biology , Culicidae , Dengue , Disease Outbreaks , Encephalitis, Japanese , Encephalomyelitis , Flavivirus , Incidence , Microcephaly , Micronesia , South America , Yellow fever virus , Zika VirusABSTRACT
Sarcocystis neurona is the primary agent for Equine Protozoal Myeloencephalitis (EPM), important neurological disease characterized by behavior or muscular changes, that impairs animal performance and husbandry. Sarcocystis cruzi is a pathogen related to myositis in cattle. Although related the life cycles of the parasites are distinct. S. neurona has opossums (Didelphis spp.) and S. cruzi, dogs as definitive hosts. However, S. neurona and S. cruzi may undergo cross-reactivity in serological tests, interfering on results of EPM ante-mortem diagnostic tests. In the present study, serology of 189 mares was performed by indirect immunofluorescence antibody test, using antigens of S. neurona and S. cruzi in order to assess the exposure degree of animals to antigens. Analyzing the results, it was observed that most of the animals (84.13%) reacted with at least one protozoal species and the number of animals which showed antibodies against S. cruzi was greater than S. neurona (80.42% and 33.86%, respectively) and a third of seropositive animals reacted to antigens of both species.(AU)
Subject(s)
Animals , Antibodies, Protozoan/analysis , Apicomplexa , Sarcocystis/isolation & purification , Sarcocystosis/veterinary , Sarcocystosis/epidemiology , Encephalomyelitis/veterinary , HorsesABSTRACT
Objetivo. Se describe un caso de una paciente femenina de 23 años de edad, con cefalea temporal unilateral izquierda de tipo opresiva, asociado a ataxia, desorientada en espacio y tiempo, y bradipsiquia. Métodos. El abordaje inicial fue hacia una posible esclerosis múltiple y asociada a la clínica y paraclínicos se sospechó una encefalomielitis diseminada aguda para lo cual inician pulsos de metilprednisolona, y dan egreso. Al mes, consulta nuevamente por exacerbación de la sintomatología neurológica dada por pérdida de la fuerza en miembros superiores e inferiores, disartria, relajación de esfínteres, somnolencia, se da como diagnóstico diferencial enfermedad de Devic, y al no obtener la respuesta adecuada a los corticoides se decide manejo con plasmaféresis, además de solicitar exámenes para descartar la patología en cuestión. Resultados. Se enfocó a la paciente con un posible diagnóstico de Síndrome de Susac solicitándose una arteriografía retiniana, y potenciales auditivos evocados.
The presented patient is a female of 23 years of age, with left-sided temporal headache, of the oppressive kind, associated with ataxia, disoriented in space and time, and mental slowing. The initial approach was to work toward a possible multiple sclerosis; then, the clinical and paraclinical tests arose the suspicion of an acute disseminated encephalomyelitis which was treated with methylprednisolone pulse and given discharge. Within a month, the patient returns for exacerbation of neurological symptoms given by loss of strength in upper and lower limbs, dysarthria, wetting, drowsiness; so the differential diagnosis that was given was Devic's disease, and as she was not responding properly to corticosteroids, it is decided to try with plasmapheresis. Finally the patient was focused with a possible diagnosis of Susac Syndrome with an arteriography paraclinical retinal and auditory evoked potentials.
Subject(s)
Humans , Susac Syndrome , Ataxia , Encephalomyelitis , Multiple SclerosisABSTRACT
Acute disseminated encephalomyelitis (ADEM) is a demyelinating and inflammatory condition of the central nervous system, occurring predominantly in white matter. ADEM involving the rhombencephalon without affecting the white matter is very rare. Here, we present an unusual case of ADEM involving only the rhombencephalon in a 4-year-old Asian girl. The patient complained of pain in the right lower extremities, general weakness, ataxia, and dysarthria. The initial brain CT showed subtle ill-defined low-density lesions in the pons and medulla. On brain MRI, T2 high signal intensity (T2-HSI) lesions with mild swelling were present in the pons, both middle cerebellar peduncles, and the anterior medulla. The initial diagnosis was viral encephalitis involving the rhombencephalon. Curiously, a cerebrospinal fluid (CSF) study revealed no cellularity, and negative viral marker findings. Three weeks later, follow up brain MRI showed that the extent of the T2-HSI lesions in the brain stem had decreased. After reinvestigation, it was found that she had a prior history of upper respiratory infection. In this case, we report the very rare case of a patient showing isolated involvement of the rhombencephalon in ADEM, mimicking viral rhombencephalitis on CT and MR imaging. ADEM can involve unusual sites such as the rhombencephalon in isolation, without involvement of the white matter or deep gray matter and, therefore, should be considered even when it appears in unusual anatomical areas. Thorough history taking is important for making a correct diagnosis.
Subject(s)
Child, Preschool , Female , Humans , Asian People , Ataxia , Biomarkers , Brain , Brain Stem , Central Nervous System , Cerebrospinal Fluid , Diagnosis , Dysarthria , Encephalitis, Viral , Encephalomyelitis , Encephalomyelitis, Acute Disseminated , Follow-Up Studies , Lower Extremity , Magnetic Resonance Imaging , Pons , RhombencephalonABSTRACT
Japanese encephalitis (JE) shows characteristic brain lesions, including bilateral thalamus, midbrain, internal capsule, basal ganglia, and occasionally involves an anterior horn cell. We encountered a case of a 44-year-old man who initially presented with encephalitis, which was finally diagnosed as Japanese encephalomyelitis with syringomyelia. The patient showed severe motor weakness followed by delayed recovery of functional motor activities. Cervical magnetic resonance imaging showed syrinx formation at the C5 level suggesting myelitis, and abnormal electromyographic findings were noted. Clinicians should consider the possibility that the spinal cord may be involved; an example would be syringomyelia due to myelitis in a case of JE presenting with severe and prolonged motor weakness.
Subject(s)
Adult , Humans , Anterior Horn Cells , Asian People , Basal Ganglia , Brain , Encephalitis , Encephalitis, Japanese , Encephalomyelitis , Internal Capsule , Magnetic Resonance Imaging , Mesencephalon , Motor Activity , Myelitis , Spinal Cord , Syringomyelia , ThalamusABSTRACT
Foi investigada a ocorrência da infecção pelos vírus da Encelafalomielite Equina do Leste (EEE), Encefalomielite Equina do Oeste (WEE) e Encefalomielite Equina Venezuelana (VEE) em equídeos não vacinados contra tais agentes, criados em dez delegacias regionais do estado de Minas Gerais (Almenara, Bambuí, Curvelo, Governador Valadares, Montes Claros, Oliveira, São Gonçalo do Sapucaí, Teófilo Otoni, Unaí e Viçosa), empregando-se a técnica de soroneutralização em microplacas. Dos 826 animais examinados, 30,2% ((250/826) foram soropositivos para EEE e 1,9% (16/826) para o zuelano de Encefalomielite Equina circulam na população equina do estado de Minas Gerais.
The occurrence of Equine Eastern Encephalomyelitis (EEE), Equine Western Encephalomyelitis (WEE) and Equine Venezuelan Encephalomyelitis (VEE) virus infection was investigated in equids not vaccinated against these viruses. The animals were distributed in ten regional districts of the state of Minas Gerais (Almenara, Bambuí, Curvelo, Governador Valadares, Montes Claros, Oliveira, São Gonçalo do Sapucaí, Teófilo Otoni, Unaí e Viçosa). Microplate serum neutralization test was used to detect antibodies against encephalitis virus. Two hundred and fifty animals (30.2%, 250/826) were EEE-seropositive, while 1.9% of them (16/826) were VEE-seropositive. No animals were found to be seropositive for WEE. In conclusion, either EEE or VEE viruses circulate in the equid population of the state of Minas Gerais.
Subject(s)
Animals , Encephalomyelitis/pathology , Viruses , Horses/classificationABSTRACT
Acute disseminated encephalomyelitis, or post infectious encephalomyelitis is an immunologically mediated demyelinating disorder affecting the central nervous system after infection or vaccination. Young and adolescents are mostly affected with characteristic diffuse neurological signs. Prognosis is generally favorable, however, fulminant acute disseminated encephalomyelitis can be fatal if not diagnosed and treated early. With an increase in intracranial pressure, the treatment of choice is methylprednisolone, followed by immunoglobulin, plasmapheresis or cytotoxic drugs. We present a case of acute disseminated encephalomyelitis in a 17 year male who presented with a sudden onset recurrent generalized tonic-clonic seizures and rapidly become comatose. Magnetic resonance imaging along with other investigations helped in establishing the diagnosis. Treatment resulted in full recovery with uneventful follow up of four years
Subject(s)
Humans , Male , Encephalomyelitis, Acute Disseminated/drug therapy , Encephalomyelitis , Magnetic Resonance ImagingABSTRACT
Guillain-Barre syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy most commonly characterized by rapidly progressive, essentially symmetric weakness and areflexia. This study examined clinical symptoms of clinical variants of GBS through a cerebrospinal fluid (CSF) study, nerve conduction (NCV) study, treatment, and prognosis. There were 16 children with GBS who visited our hospital from January 2011 to December 2013. Guillen-Barre-like syndromes with transient synovitis were noted in three children. Clinical variants of GBS with acute demyelinating encephalomyelitis were observed in one child. Previous infections were noted in 16 children with Guillen-Barre-like syndrome. There were ascending infections in 16 cases. Fifteen children showed symmetric infections, and one showed asymmetric infection. In NCV, slow waves were noted in two cases. We treated using intravenous immunoglobulin (IVIG) in four cases, IVIG with steroid in two, cases and supportive care in 10 (62.5%) cases. Five children treated with IVIG and 10 with supportive care management were completely improved.Our study suggests that supportive care is effective as a treatment for clinical variants of GBS. Further study is necessary for more patients.
Subject(s)
Child , Humans , Cerebrospinal Fluid , Encephalomyelitis , Guillain-Barre Syndrome , Immunoglobulins , Immunoglobulins, Intravenous , Neural Conduction , Prognosis , SynovitisABSTRACT
Galectin-3 is a beta-galactoside-binding lectin that plays a role in neuroinflammation through cell migration, proliferation, and apoptosis. In the present study, regulation of galectin-3 was examined in the brain of mice infected with the Daniel strain of Theiler's murine encephalomyelitis virus (TMEV) at days 7 and 81 post-infection by immunohistochemistry. Immunohistochemistry revealed that galectin-3 was mainly localized in ionized calcium-binding adapter 1-positive macrophages/activated microglia, but not in Iba-1-positive ramified microglia. Galectin-3 was also weakly detected in some astrocytes in the same encephalitic lesions, but not in neurons and oligodendrocytes. Collectively, the present findings suggest that galectin-3, mainly produced by activated microglia/macrophages, may be involved in the pathogenesis of virus induced acute inflammation in the early stage as well as the chronic demyelinating lesions in Daniel strain of TMEV induced demyelination model.
Subject(s)
Animals , Mice , Apoptosis , Astrocytes , Brain , Cell Movement , Demyelinating Diseases , Encephalomyelitis , Galectin 3 , Immunohistochemistry , Inflammation , Macrophages , Microglia , Neurons , Oligodendroglia , Theilovirus , VirusesABSTRACT
Enterovirus infection is often aggravated and manifests as various neurological complications such as aseptic meningitis, brainstem encephalitis, poliomyelitis-like acute flaccid paralysis, transverse myelitis, and severe systemic diseases. There are a few reports indicating that enterovirus is associated with acute disseminated encephalomyelitis (ADEM), acute flaccid paralysis, or Guillain-Barre syndrome separately. However, none of these report ADEM and acute flaccid paralysis occurring simultaneously. Here, we present a case of combined ADEM and acute flaccid paralysis associated with enteroviral infection in a child and reviewed the relevant literature. A 5-year-old boy was admitted to the hospital for headache and vomiting with evident meningeal irritation signs. Despite of antibiotic therapy, his mental state rapidly declined to coma with abnormal upper motor neuron (UMN) signs. During 5 consecutive days of steroid pulse therapy, his abnormal UMN signs abruptly changed to flaccid paralysis. Suspected acute flaccid paralysis due to enterovirus prompted the addition of intravenous immunoglobulin (IVIG). On hospital day 33, he was discharged with full recovery of muscle tone and strength with an alert mental state.