1. 88% (21/24) of the patients had severe pain, which was usually symmetric (18/21) and located in one or more spinal segments (11/21), although 6 patients had leg pain and 5 had headaches.
2. Fever was a presenting symptom in 14 of 24 patients and was not more common in the patients with a prior infection.
3. Neurologic symptoms were present initially in only 50% of the patients and consisted of motor loss (10/12) or sphincter dysfunction (4/12).
4. Sudden onset of a severe motor deficit was noted in 8 patients, of whom 7 became unable to walk within 12 hours and one had respiratory insufficiency.
5. The motor symptoms antedated the sphincter dysfunction in two thirds of the patients (16/24) and were asymmetric in 71%.
6. Back pain was noted in 75% (18/24) of patients, more commonly in the neck (56%, 10/18); all but 1 patient had flaccid paralysis.
7. The motor deficit became symmetric in 67% (16/24) of the patients.
8. The lower limb weakness was severe in 18 (75%) patients, and one or more deep tendon reflexes in the lower limbs were abolished in 20 (83%) patients.
9. Weakness in the upper limbs was present in 10 (42%) patients and was consistently moderate.
10. A single patient had tetraplegia.
11. Abnormalities in sensation were found in 19 (83%) patients, being asymmetric in 20 (82%) patients and consistent with a thoracic lesion in 21 (88%) patients and with a cervical lesion in 3 (12%) patients.
12. Sphincter dysfunction was present in 20 patients: in 12 patients, whereas in 8 patients, the dysfunction was moderate; 11 patients had anal sphincter dysfunction.
13. Optic neuritis was present in 4 patients.
Recovery phase (n=16)
14. 2 (13%) children had severe motor sequelae.
15. 8 (50%) patients recovered normal motor function. 4 (25%) patients had moderate motor sequelae and 2 (13%) had mild motor sequelae.
16. Sensory abnormalities resolved completely in 7 children (54%).
17. Of the 15 patients with sphincter dysfunction, 5 (33%) recovered normal sphincter function within a mean of 7 months (15 days-2 yr), 5 (33%) had mild sequelae, and 5 (33%) had severe sequelae.
18. According to Paine’s scale, 5 (31%) children achieved a full recovery, 4 (25%) had minimal sequelae, and 7 (44%) had mild or severe sequelae.
19. Supraspinal symptoms recovered fully in all 16 patients.
20. An unfavorable outcome was more common among patients with complete paraplegia (p=0.03) and/or a time to maximal deficit shorter than 24 hours (p=0.005).
21. A favorable outcome was associated with a plateau shorter than 8 days (p=0.03), the presence of supraspinal symptoms (p=0.01), and a time to independent walking shorter than 1 month (p=0.01).
22. Abnormalities were found in 15 (62%) patients. The white blood cell count ranged from 0 to 1800/µL (mean 210/µL), and lymphocytes were the main cell type in 12 of 15 patients.
23. The protein level was slightly elevated (up to 120 mg/dL) in 3 (20%) patients.
24. Cerebrospinal fluid protein electrophoresis was normal in 9 of 13 patients and showed a pattern consistent with a transudate (no oligoclonal bands) in the remaining 4 patients.
25. 5 of 24 patients had serologic evidence of a recent viral infection (herpes simplex virus, n1=; Epstein-Barr virus, n=1, varicella-zoster virus, n=1; and measles, n=2).
26. 2 of 6 children who underwent spinal MRI had normal findings; among the 4 other children, 1 had multiple lesions in the cervical region and conus medullaris and 3 each had a single lesion in the thoracic spinal cord.
27. Edema of the spinal cord was visible on T1-weighted sequences in 2 children.
28. On T2-weighted sequences, all lesions exhibited high signal intensity and extended along two or more vertebral segments.
29. In 3 children, the high-signal lesions on the T2-weighted sequences of the initial MRI showed postgadolinium enhancement in a nodular (n=1), diffuse (n=1), or peripheral (n=1) pattern.
30. Among the 4 patients who underwent cerebral MRI, only 1 had abnormal findings, which consisted of multiple areas of high signal in the cortex and basal ganglia on T2-weighted sequences.
31. Follow-up MRI was performed in 3 patients and showed a return to normal in 2; the remaining patient had cervical and conus lesions on the initial MRI and persistent high signal in the conus on T2-weighted sequences after 4 months.