Clinical Case Database / Category: Clinical Care
A totally reversible cause of mobility loss in an elderly patient
Publication details
Dr Thomas Bartlett, Dr Khaled Amar
Foundation Years Journal, volume 4, issue 3, p.40 (123Doc Education, London, March 2010)
Abstract
An 80-year-old man presented with an 8-weeks history of progressive lower limbs weakness of lower motor neuron-type, rendering him unable to weight bear. There was no history of back pain or trauma, and he denied bladder or bowel problems. Investigations including blood tests and MRI of the spine were normal, while CSF examination revealed increased protein level. Nerve conduction studies showed evidence of proximal conduction block, suggestive of inflammatory demeylination. Our patient responded well to immune suppression with intravenous immunoglobulin and oral steroids. He became mobile with a rolator within 2 weeks and independently mobile after 4 weeks of starting treatment. The clinical diagnosis was chronic inflammatory demyelinating polyneuropathy (CIDP). CIDP can be thought of as a subacute or chronic onset Guillan–Barré syndrome (GBS). CIDP is probably under diagnosed in the elderly. It needs to be considered in all elderly patients with progressive loss of mobility.
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Authors
Dr Thomas Bartlett
FY1 Doctor in Elderly Care
Royal Bournemouth and Christchurch NHS hospitals,
Dorset
Dr Khaled Amar
Consultant Physician and Geriatrician
Royal Bournemouth and Christchurch Hospitals
Castle Lane East
Dorset BH7 7DW
khaled.amar@rbch.nhs.uk
References
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2. Hughes R (2002) Regular Review: Peripheral Neuropathy, British Medical Journal, 324:466–469.
3. Laughlin RS, Dyck PJ, Melton LJ, et al. (2009) Incidence and prevalence of CIDP and association of diabetes mellitus. Neurol, 73:39–45.
4. Hughes R (2002) Chronic Inflammatory Demyelinating Polyradiculoneuropathy, Practical Neurology, 2:198–207.
5. The French CIDP Study Group. Recommendations on Diagnostic Strategies for Chronic Inflammatory Demyelinating Polyradicleuropathy, Journal of Neurology, Neurosurgery and Psychiatry, 79:115–118.
6: Köller H, Keiseier, B, Jander S, Hartung H (2005) Chronic Inflammatory Demyelinating Polyneuropathy, The New England Journal of Medicine, 352:1343–1356.
7: Ad Hoc Subcommittee of the American Academy of Neurology AIDS Task Force (1991) Research criteria for the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Neurology, 41:617–618.
8: Hughes R, Bensa S, Willison H, Van den Bergh P, et al. (2001) Randomized Controlled Trial of Intravenous Immunoglobulin Versus Oral Prednisolone in Chronic Inflammatory Demyelinating Polyradiculopathy, Annals of Neurology, 50:195–201.
9: Richard AC, Hughes MD, et al. (2008) Intravenous immune globulin (10% caprylate-chromatography purified) for the treatment of chronic inflammatory demyelinating polyradiculoneuropathy (ICE study): a randomised placebo-controlled trial. The Lancet Neurology, 7:136–144.
10: Hahn AF, Bolton CF, Pillay N, et al. (1996) Plasma-exchange therapy in chronic inflammatory demyelinating polyneuropathy: a double-blind, sham-controlled, cross-over study. Brain, 119:1055–1066.
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The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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