00:02
Now let's turn to a case.
00:03
This is a 55-year-old who presents
with a three month course
of progressive weakness
in the legs.
00:10
He first started to notice
this at work three months ago
and has become progressively weaker
to the point
that he is not able to work
and has been using a cane
for support.
00:18
He reports sensory loss
in his feet with numbness
and tingling in his toes.
00:23
Recently, he's also noticed symptoms
in both hands as well.
00:26
He denies bulbar symptoms,
and examination confirms
four out of five weakness
that is symmetric in both legs,
except three out of five strength
with dorsiflexion bilaterally.
00:37
There is subjective numbness
in his feet to the toes,
and deep tendon reflexes
show diffuse areflexia.
00:45
So this case is very similar to our
Guillain-Barre description in case.
00:49
However, this patient's symptoms
began over three months.
00:52
He has a slowly progressive,
gradually progressive process
that has all of the
features of a neuropathy.
00:59
There's symmetric weakness,
sensory changes
and diffuse areflexia.
01:05
This patient underwent workup
that included a lumbar puncture
showing no white blood cells
but elevated CSF protein of 75
and normal CSF glucose.
01:14
So that's an inflammatory LP
that's our
albuminocytological dissociation.
01:19
Nerve conduction study
showed neuropathic changes
with significantly reduced
conduction velocity,
temporal dispersion,
which is the demyelinating feature.
01:28
Absent if F-waves
also at the myelinating feature,
and reduced recruitment,
which we see with neuropathies.
01:35
And all of this is consistent
with a peripheral nerve
demyelinating disorder.
01:40
So what's your diagnosis?
Is this chronic inflammatory
demyelinating polyneuropathy?
Multifocal motor neuropathy?
Acute intermittent
demyelinating polyneuropathy?
Or acute motor
and sensory axonal polyneuropathy.
01:54
Well, this presentation
isn't consistent
with a multifocal pattern.
01:58
This is symmetric, so it's not
multifocal motor neuropathy.
02:01
This is not the description of AIDP.
02:04
We see a lot of those features,
however, this patient's symptoms
continue to progress
after eight weeks.
02:10
And that's inconsistent with
AIDP and suggestive of CIDP.
02:15
This is not an axonal
predominant process.
02:17
We saw a lot of features
of dmyelination
on the nerve conduction study.
02:21
And so that's inconsistent
with acute motor and sensory
axonal polyneuropathy.
02:26
And so this is
the typical presentation of CIDP.
02:29
A chronic progressive onset,
a condition over eight weeks
localizing to the peripheral nerve
with inflammatory changes on LP
and demyelination
on the nerve conduction study.
02:41
Let's talk a little bit more
about CIDP.
02:44
What's the description?
What a patient's describe?
Well, it's a rare inflammatory
disorder of the peripheral nerves?
It is chronic and onset,
with symptoms continuing
to worsen after eight weeks
and that's critically important
in differentiating it from AIDP.
02:57
It's slowly progressive.
02:58
There's symmetric weakness,
more than numbness.
03:01
So there is a sensory changes
but the motor changes
are often out of proportion
to the sensory findings.
03:07
And areflexia is prominent.
03:08
This is an inflammatory
polyradicular neuropathy,
where we see diffuse areflexia.