Comprehensive analysis of acute flaccid paralysis with and without myelitis in Taiwanese children

Figures

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  Fig. 1. Flowchart of the study

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  Fig. 2. Detailed Interpretation and Figure Legends for MRI Images of selective patients with Myelitis. (A) Sagittal T2W (left) and STIR (right) MRI of the thoracolumbar spine in a 17-year-old female with multiple sclerosis. Vertebral levels T11, T12, and L1 are labeled, with red stars indicating hyperintense lesions due to demyelination. (B) Sagittal T2W (left) and STIR (right) MRI of the cervical spine of a 4-year-old male with Enterovirus D68 infection. Vertebral levels C4, C5, C6, and C7 are labeled, showing hyperintense signals indicative of myelitis. (C) Sagittal and axial T2-weighted MRI of the thoracolumbar spine of an 18-year-old female with Systemic Lupus Erythematosus. Vertebral levels T9, T10, T11, T12, and L1 are labeled. The sagittal view shows hyperintense lesions, and the axial view at T12-L1 highlights spinal cord inflammation consistent with myelitis. MRI, Magnetic Resonance Imaging; T2W, T2-Weighted; STIR, Short Tau Inversion Recovery; MS, Multiple Sclerosis; EV-D68, Enterovirus D68; SLE: Systemic Lupus Erythematosus

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  Fig. 3. A 4-year-old girl with bone metastasis from right adrenal neuroblastoma. (A) Sagittal MRI showing a large, heterogeneous mass in the right adrenal gland, indicated by the red arrow. (B) Sagittal MRI showing multiple vertebral lesions with low itensities, marked by red asterisks (T7, T9 and T11). These lesions show altered signal intensity compared to normal vertebral marrow, indicating metastatic involvement. (C) F-18 FDG Whole Body PET Scan: The areas of increased uptake correspond to sites of active tumor growth, including the primary adrenal mass, spine, and possibly other distant organs such as the liver or lymph nodes. The overall pattern of distribution suggests extensive dissemination of neuroblastoma cells. (D) Axial MRI at the T12 level showing a metastatic spread of neuroblastoma mass in the left epidural space (yellow arrow), leading to neurological symptoms such as pain, weakness and sensory deficits. MRI, Magnetic Resonance Imaging; F-18 FDG, Fluorodeoxyglucose (F-18); PET, Positron Emission Tomography

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  Fig. 4. MRI and Electrophoresis Findings in Patients with Traumatic Injury (A) and Guillain-Barre Syndrome (B-D): (A) The Sagittal T2-weighted MRI of a 3-year-old boy who suffered from a traffic injury. The red arrow indicates a visible injury at the C7-C8 vertebral level, suggesting a spinal cord injury secondary to the accident. (B) The Sagittal T2-weighted MRI of a 17-year-old girl with GBS. Yellow arrows highlight spinal nerve root enhancement at the T10 and T11 vertebral levels, indicating inflammation and demyelination associated with GBS. (C) Yellow arrows in the Axial T2-weighted MRI indicate nerve root enhancements, consistent with the inflammatory process of GBS. (D) The gel of cerebrospinal fluid protein electrophoresis shows an abnormal gamma (γ) band, indicative of an immune response, the autoimmune nature of GBS. MRI, Magnetic Resonance Imaging; GBS, Guillain-Barre Syndrome; T2W, T2-Weighted