Post-Polio Syndrome in a Primary Care Setting: A Case Report

Post-Polio Syndrome (PPS) is a sequela of poliovirus infection that causes weakness in previously infected polio patients years after the initial infection. The diagnosis is one of exclusion and entails the following: 1) a prior episode of poliomyelitis with residual motor neuron function loss, 2) a period of at least 15 years or more after the acute onset of polio with neurologic and functional stability, and 3) a gradual onset of new weakness and abnormal muscle fatigability that has persisted for at least one year. While the exact etiology is unknown, the prevalence of PPS has increased as patients who have previously survived polio are getting older. In this report, we discuss a patient presenting to his primary care provider for evaluation of worsening lower extremity weakness over the course of the past three years. In addition to general characteristics of PPS, we will review the use of electromyography (EMG)/nerve conduction studies and imaging for evaluation. This report will also review prevention methods with vaccinations and identify potential treatment regimens including aerobic exercise and medications ranging from tricyclic antidepressants (TCAs) to dopamine agonists. The goal of this paper is to not only shine a light on PPS in general, but to show how social determinants i.e., economic stability, healthcare access and quality of health may affect the diagnosis of uncommon conditions.