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

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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

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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

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Meningeal signs may be present on physical exam:[2]

* Nuchal rigidity
* Positive Kernig's sign
* Positive Brudzinski's sign

## Paralytic Poliomyelitis

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### Spinal Paralytic Poliomyelitis

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#### Temperature

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* A fever is often present

#### Extremities

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* 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

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* Meningeal signs may be present on physical exam, such as:[2]

* Nuchal rigidity
* Kernig's sign
* Brudzinski's sign

* 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

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#### Neurologic

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* 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

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#### Neurologic

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* Seizures are often present
* Spastic paralysis may be present

## References

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1. ↑ "Poliomyelitis".
2. ↑ 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.

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