A 21-year-old male presented with 4 years of progressive arm and leg weakness, wasting,
areflexia, length-dependent sensory loss, and difficulty walking. Electrodiagnostic studies
met diagnostic criteria for chronic inflammatory demyelinating polyneuropathy (CIDP)11 Van den Bergh PY, Hadden RD, Bouche P, Cornblath DR, Hahn A, Illa I et al.
European Federation of Neurological Societies/Peripheral Nerve Society guideline on
management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint
task force of the European Federation of Neurological Societies and the Peripheral Nerve
Society-First Revision. Eur J Neurol. 2010;17(3):356-63.
http:dx.doi.org/10.1111/j.1468-1331.2009.02930.x. CSF analysis showed elevated total protein.
MRI of the head (Figures 1 and 2) and spinal cord (Figure 3) showed
spinal root hypertrophy and enhancement as well as thickening and enhancement of the
trigeminal nerves. The most distal branches of the trigeminal nerve, such as the
supraorbital22 Okuzumi A, Hatano T, Nakahara T, Yokoyama K, Hattori N. Ophthalmic nerve
hypertrophy in chronic inflammatory demyelinating polyradiculoneuropathy. Neurology.
2014;82(17):1566-7. http://dx.doi.org/10.1212/WNL.0000000000000362
https://doi.org/10.1212/WNL.000000000000...
, frontal or inferior alveolar
nerves, are seldom portrayed in reports of CIDP.
T2-weighted imaging demonstrating enlargement of trigeminal nerve divisions and distal branches in coronal sections. (A): maxillary nerve (arrow) and mandibular nerve (arrowhead); (B): maxillary nerve (dashed arrow) and mandibular nerve branches: buccal nerve (arrowhead), lingual nerve (short arrow) and inferior alveolar nerve (long arrow); (C): Frontal nerves (ophthalmic nerve branches; arrows).
Parassagital FLAIR sections of the head. (A): frontal nerve (ophthalmic nerve branch; arrow), maxillary nerve (dashed arrow) and mandibular nerve (arrowheads). (B): Inferior alveolar nerve (mandibular nerve branch; arrowheads).
References
-
1Van den Bergh PY, Hadden RD, Bouche P, Cornblath DR, Hahn A, Illa I et al. European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society-First Revision. Eur J Neurol. 2010;17(3):356-63. http:dx.doi.org/10.1111/j.1468-1331.2009.02930.x
-
2Okuzumi A, Hatano T, Nakahara T, Yokoyama K, Hattori N. Ophthalmic nerve hypertrophy in chronic inflammatory demyelinating polyradiculoneuropathy. Neurology. 2014;82(17):1566-7. http://dx.doi.org/10.1212/WNL.0000000000000362
» https://doi.org/10.1212/WNL.0000000000000362
Publication Dates
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Publication in this collection
July 2015
History
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Received
26 Jan 2015 -
Reviewed
18 Feb 2015 -
Accepted
11 Mar 2015