Abstract
Background
The patient is A 88-year-old lady who initially presented for workup of a pelvic mass but subsequently found to have a rapidly progressing weakness of both legs and hands.
5 weeks ago, the patient was independent with all activities of daily living. Currently, the patient had bilateral foot drop worst on the left, bilateral wrist drops, impaired pain and proprioception with preservation of reflexes on clinical examination.
Investigation and Treatment
On initial presentation, patient had raised ESR 110 and raised CRP 115 with unclear cause. Septic screen and cultures were negative. Autoimmune screen was negative.
CSF studies including cultures, chemistry, oligoclonal bands and cytology were normal
Neuroimaging including MRI scan of the entire spine and CT brain were normal
Significantly raised paraproteins but polyclonal and non-specific.
Nerve conduction studies confirmed severe sensory axonal polyneuropathy, but interpretation greatly limited by patients’ ability to tolerate the examination. Coexisting motor neurone involvement could not be excluded on current study.
Was treated with IVIG using CIDP protocol with some improvement in patient’s motor function.
Investigation and TreatmentGoals and learning points of presentation.
To highlight the challenges and difficulty in managing a patient with rapidly progressive polyneuropathy in the geriatric age group with unclear cause
To initiate an open discussion regarding the approach to diagnosis and management of these patients
