Chronic inflammatory demyelinating polyradiculoneuropathy associated intracranial hypertension
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LETTER TO THE EDITOR
Chronic inflammatory demyelinating polyradiculoneuropathy associated intracranial hypertension Ayca Altinkaya • Baris Topcular • Nazan Karagoz Sakalli Demet Yandim Kuscu • Dursun Kirbas
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Received: 8 April 2012 / Accepted: 21 August 2012 / Published online: 1 September 2012 Ó Springer-Verlag 2012
Abstract Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired immune-mediated demyelinating neuropathy. In this report, we detail the course of a 58-year-old male patient who had headache and double vision followed by progressive paresthesia and difficulty in walking. The patient had bilateral papilledema and mild leg weakness, absent ankle jerks and loss of sensation in distal parts of his lower and upper extremities. His electromyography (EMG) was concordant with CIDP and lumbar puncture revealed high opening pressure. The polyradiculoneuropathy as well as the papilledema and elevated cerebrospinal fluid (CSF) pressure improved under steroids. The improvement in intracranial hypertension (IHT) and papilledema under steroid treatment suggests that the IHT in this patient might be associated with CIDP. A. Altinkaya (&) B. Topcular Department of Neurology, Istanbul Bilim University, Istanbul, Turkey e-mail: [email protected] B. Topcular e-mail: [email protected] A. Altinkaya Bedrettin Dalan Mah, Bedii Gorbon Sk, No: 1 Sishane, Beyoglu, Istanbul, Turkey N. K. Sakalli D. Y. Kuscu D. Kirbas Department of Neurology, Dr. Mazhar Osman Teaching and Research Hospital for Mental Health and Neurological Disorders, Istanbul, Turkey e-mail: [email protected] D. Y. Kuscu e-mail: [email protected] D. Kirbas e-mail: [email protected]
Keywords Headache Papilledema Chronic inflammatory demyelinating polyradiculoneuropathy
Introduction Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired immune-mediated demyelinating neuropathy. CIDP usually presents as a more or less symmetric sensorimotor polyradiculoneuropathy with insidious or stuttering progression or episodic exacerbations and diffuse hyporeflexia or areflexia. The cerebrospinal fluid (CSF) demonstrates albuminocytologic dissociation. There is an increase in the level of albumin in CSF without an accompanying increase in the number of cells. Nerve conduction studies typically show demyelination. Nerve biopsy shows unequivocal evidence of demyelination and/or remyelination. Intracranial hypertension (IHT) is an unusual feature of CIDP. Papilledema associated with acute inflammatory demyelinating polyradiculoneuropathy has been described in literature, however CIDP associated IHT is very rarely reported. We present a patient with CIDP associated IHT.
Case report A 58-year-old male patient was admitted to the hospital, because of headache, progressive paresthesia and weakness for almost 6 months. His first symptom was gradually ascending progressive paresthesia in both legs. About a month later a continuous headache started, which was accompanied by double vision in the following weeks
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