Acute flaccid myelitis (AFM) is a serious condition of the spinal cord. Symptoms include rapid onset of arm or leg weakness and decreased reflexes. Difficulty moving the eyes, speaking, or swallowing may also occur. Occasionally, numbness or pain may be present. Complications can include trouble breathing.The cause of most cases is unclear as of 2018. More than 90% of recent cases have followed a mild viral infection such as from enteroviruses. While polio can cause AFM, since 2014, it has not been involved in cases in the United States. The underlying mechanism involves damage to the spinal cords grey matter. Diagnosis may be supported by medical imaging of the spine, nerve conduction studies, and cerebrospinal fluid testing.Treatment involves supportive care. Physical therapy may be recommended. Occasionally, mechanical ventilation is required to support breathing. Outcomes are variable. The condition is rare and occurs most commonly in children. Fewer than one in 500,000 children is affected per year in the United States. Although the illness is not new, an increase in cases has been seen since 2014 in the United States. In 2018,  233 cases were confirmed in the United States. Signs and symptoms
Symptoms include:

Difficulty moving the eyes or drooping eyelids
Facial droop or weakness
Difficulty with swallowing or slurred speech
Sudden arm or leg weaknessA summary of the condition by the Centers for Disease Control and Prevention (CDC) in 2014:
Common features included acute focal limb weakness and specific findings on magnetic resonance imaging (MRI) of the spinal cord consisting of nonenhancing lesions largely restricted to the grey matter.
Zieves syndrome is an acute metabolic condition that can occur during withdrawal from prolonged heavy alcohol use. It is defined by hemolytic anemia (with spur cells and acanthocytes), hyperlipoproteinaemia (excessive blood lipoprotein), jaundice (elevation of unconjugated bilirubin), and abdominal pain. The underlying cause is liver delipidization. This is distinct from alcoholic hepatitis which, however, may present simultaneously or develop later.Diagnosis of Zieves syndrome should be considered in patients with prolonged alcohol use (especially after an episode of binge drinking) with an elevation of unconjugated bilirubin and without obvious signs of gastrointestinal bleeding. Pathogenesis
The proposed mechanism of the characteristic haemolytic anaemia in Zieves syndrome is due to alteration of the red cell metabolism, namely pyruvate kinase instability leaving them susceptible to circulating hemolysin such as lysolecithin. Changes in membrane lipid compositions such as increased cholesterol and polyunsaturated fatty acid (PUFA) have been reported during the hemolytic phase. Diagnosis
The diagnosis is demonstrated by the triad of alcoholic hepatitis or cirrhosis, hemolytic anemia, and hyperlipidemia. Treatment
Definitive treatment for Zieves syndrome is alcohol cessation. Individuals with markedly elevated triglycerides, particularly with a history of pancreatitis or intracerebral hemorrhage, may require plasmapharesis to avoid complications associated with hypertriglyceridemia. History
Zieves syndrome was initially described in 1958. Dr. Leslie Zieve described patients with a combination of alcoholic liver disease, hemolytic anemia and hypertriglyceridemia. References


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