There may be a history of respiratory infection or diarrhea or other manifestations of Coxsackie viral disease, but not necessarily so. It might be rather acute onset of paraplegia with or without sensory loss and with sphincter dysfunction. It is mani­fested usually within hours, days, up to a week. The previous history of viral disease (fl u) suggests an immune-mediated pathogenesis. There is fl accid paralysis with loss of the refl exes including the rectal and bulbocavernous refl exes. Sensory loss may be associated with the motor loss. The picture is not specifi c for Coxsackie viruses, but occurs with other viral infections, and sometimes ATM is idiopathic. The course of the disease is variable depending on the time of the diagnosis and the effi ciency of the management. Early management may lead to complete recovery motor and sensory-wise within months, and occurs in one-third of the cases; one­third gets partial recovery and one-third become chronically disabled and some of them die. Poor prognostic signs include extensive paralysis, widespread abnormal changes in the cord in the MRI and abnormal fi ndings in somatosensory evoked potentials. Other CNS viral infections add to the risks.