Chronic inflammatory demyelinating polyneuropathy: diagnosis and management.
Over the course of 8 weeks, a 50-year-old man developed progressive bilateral leg and arm weakness, with numbness and tingling of the feet and hands. His symptoms persisted for 6 months, with impaired manual dexterity, arm weakness when brushing his teeth, tripping when walking, inability to climb stairs and gait imbalance. On examination, there is mild proximal and distal weakness of the upper and lower extremity muscles, length-dependent sensory loss of vibratory perception and joint position sense, areflexia, positive Romberg test and steppage gait with bilateral foot drop. Motor nerve conduction studies of the arms and legs show partial conduction blocks in several nerves with nonuniform slowing, and sensory responses are absent in the hands, however, normal sural responses are noted. Lumbar puncture reveals acellular cerebrospinal fluid with elevated protein. After 2 months following treatment, his strength and gait improved significantly, and his sensory symptoms resolved.
De Sousa
Eduardo A
EA
Neuromuscular Medicine, Department of Neurology, Jefferson Medical College, Thomas Jefferson University, 900 Walnut Street, Ste 200, Philadelphia, PA 19107, USA. eduardo.desousa@jefferson.edu
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001132:Arm / Q000503:physiopathology; D002555:Cerebrospinal Fluid / Q000737:chemistry; D006801:Humans; D006987:Hypesthesia / Q000503:physiopathology / Q000628:therapy; D007116:Immunization, Passive; D007866:Leg / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016472:Motor Neuron Disease / Q000175:diagnosis* / Q000628:therapy*; D018908:Muscle Weakness / Q000209:etiology / Q000628:therapy; D009431:Neural Conduction; D010951:Plasma Exchange; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000175:diagnosis* / Q000628:therapy*; D004856:Postural Balance; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function
D000305:Adrenal Cortex Hormones