Clinical Case Database / Category: Clinical Care
A totally reversible cause of mobility loss in an elderly patient
Dr Thomas Bartlett, Dr Khaled Amar
Foundation Years Journal, volume 4, issue 3, p.40 (123Doc Education, London, March 2010)
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 Guillanâ€“BarrÃ© 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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Dr Thomas Bartlett
FY1 Doctor in Elderly Care
Royal Bournemouth and Christchurch NHS hospitals,
Dr Khaled Amar
Consultant Physician and Geriatrician
Royal Bournemouth and Christchurch Hospitals
Castle Lane East
Dorset BH7 7DW
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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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