Electrolyte imbalance triggering relapse of inflammatory neuropathy

We describe a case of a 71 year old female with a fourteen year history of chronic inflammatory demyelinating polyneuropathy (CIDP) and stable monoclonal gammopathy, normally maintained on three–weekly intravenous immunoglobulin (IVIG) therapy. At her best baseline, she has a normal motor examination and reduced vibration sense only to the ankles. She presented with a four week history of progressive numbness and paresthesiae in all four limbs, reduced balance, a decline in mobility with frequent falls and reduced hand function. The deterioration developed after a week of non–bloody diarrhoea with night sweats but continued to progress through two courses of her regular IVIG. She also had a past history of breast cancer, hypertension and a duodenal ulcer. On examination she had a profound sensory ataxia and pseudo–athetosis of the upper limbs. Power was preserved. Pinprick was reduced to the forearm and thighs. Vibration sense was present only at the sternum. Proprioception was reduced to the shoulders and hips. She was areflexic. General examination was normal. Blood investigations showed hypomagnesaemia of 0.1 (range 0.6–1.0), hypocalcaemia of 1.75 (range 2.15–2.55), mild hypokalaemia of 3.2 (range 3.5–5.1) but stable renal function. Nerve conduction studies showed a length–dependent demyelinating sensorimotor neuropathy with significant deterioration from previous studies. Her paraprotein level was stably low. Thus we considered th...
Source: Journal of Neurology, Neurosurgery and Psychiatry - Category: Neurosurgery Authors: Tags: Neurogastroenterology, Immunology (including allergy), Drugs: CNS (not psychiatric), Multiple sclerosis, Neuromuscular disease, Peripheral nerve disease, Stroke, Hypertension Association of British Neurologists (ABN) joint meeting with the Royal College Source Type: research