| Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access |
| Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc |
| Journal website http://www.journalmc.org |
Case Report
Volume 7, Number 12, December 2016, pages 524-526
Acute Onset of Chronic Inflammatory Demyelinating Polyneuropathy: A Case Report
Table
| Episode | Speech | Face | Upper limbs | Lower limbs | Other signs | EMG characteristics | Cerebrospinal fluid results |
|---|---|---|---|---|---|---|---|
| *Muscle strength graded according to the manual muscle test (MMT) grading system. | |||||||
| 1 | Dysphasia | Bilateral facial palsy; incomplete eyelid closure with a gap of 3 mm | Absence of reflexes in bilateral biceps and triceps tendons | Muscle strength* graded 4; hyperalgesia in glove and stocking distributions; tenderness in the calves; loss of deep sensation; absence of reflexes in radial periosteal and Achilles tendon, and reduced reflex in the left patellar tendon | Positive Romberg sign | Presence of sensory evoked potentials (SEPs) in bilateral sural nerve endings, the absence or weakness of SEPs in other peripheral sensory and motor nerve endings, and absence of the bilateral tibial H-reflex. | CSF cell count: 2 × 106/L; protein: 0.65 g/L; chlorine level: 115.0 mmol/L; Pandy test: + |
| 2 | Dysphasia | Bilateral facial palsy | Muscle strength* graded 4 with weaker grip strength in the left hand; absence of reflexes in bilateral biceps and triceps tendons | Muscle strength graded 3; increased sensitivity to pain in his feet, deep sensation loss in both legs; absence of reflexes in radial periosteal, patellar tendon, and Achilles tendon | Positive Romberg sign | The lower limb muscles had neurogenic changes, an absence of SEPs in peripheral sensory and motor nerve endings in all limbs, and an absence of the bilateral tibial nerve H-reflex. | CSF cell count: 9 × 106/L; protein: 0.94 g/L; chlorine level: 116.0 mmol/L; Pandy test: + |
| 3 | Hoarse voice | (-) | Absence of all tendon reflexes; hypalgesia (10 cm distal to the elbows) | Muscle strength graded 4-; absence of all tendon reflexes; hypalgesia (10 cm distal to the knees) | Positive Romberg sign | (-) | CSF cell count: 1 × 106/L; protein: 2.63 g/L; chlorine level: 122.60 mmol/L; Pandy test: ++ |