Chronic inflammatory demyelinating polyradiculoneuropathy: two cases with cervical spinal cord compression

Abstract

-Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a peripheral nerve disorder probably due to an immunological disturb. It evolves either in a steadily progressive or in a relapsing and fluctuating course. Weakness is mainly in the lower limbs proximally and distally. The electro m y ography is demyelinating. The cerebral spinal fluid protein is most of times elevated. Sometimes enlarged nerves are found. There are few cases described with spinal cord compression due to hypertrophic spinal n e rve roots. Two patients (females, 66 and 67 years old) with diagnosis of a long standing CIDP are described. In the first one, the evolution was characterized by remission and relapsing course. The second patient had a chronic and pro g ressive course. These patients presented after a long evolution a cervical spinal cord c o m p ression syndrome due to hypert rophic cervical roots. Neurologists must be aware of the possibility of development of spinal cord compression by enlarged spinal roots in patients with a long standing CIDP.KEY WORDS: chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), spinal root hypert rophy, spinal cord compression.

Pain in Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Systematic Review and Meta-Analysis

“…For the majority of patients, the phenotype of pain was not characterized in detail. Amongst the patients for whom the phenotype of pain was described ( n = 22), 15 (68%) experienced only proximal/radicular type of neuropathic pain (including lower back pain), three (14%) experienced only distal peripheral neuropathic pain, and four (18%) a combination of proximal/radicular and distal neuropathic pain [18, 24–26, 28–33, 35, 37, 40, 41, 44, 45, 47, 49].…”

Lower motor neuron syndrome due to cauda equina hypertrophy with onion bulbs

“…15 Nerve root hypertrophy may be extreme and even lead to spinal cord compression with signs of myelopathy. [16][17][18][19][20] Nerve root hypertrophy in the cauda equina can lead to symptoms of lumbar stenosis that resolve or improve with decompressive laminectomy 21,22 (although immune suppressive therapy should first be attempted).…”

“…Nerve root hypertrophy in CIDP patients is not uncommon and was reported in 8 of 14 consecutive patients evaluated by MRI . Nerve root hypertrophy may be extreme and even lead to spinal cord compression with signs of myelopathy . Nerve root hypertrophy in the cauda equina can lead to symptoms of lumbar stenosis that resolve or improve with decompressive laminectomy (although immune suppressive therapy should first be attempted).…”

Magnetic resonance imaging of suspected idiopathic bilateral C2 hypertrophic ganglioneuritis in dogs

“…CIDP has also been shown to cause significant spinal cord compression because of bilaterally symmetrical enlargement of the nerve roots (Maurice‐Williams & Garlick , Freitas et al . ). Five of the eight dogs with clinically significant C2 nerve root lesions were treated with corticosteroids and showed improvement of clinical signs at follow‐up examinations.…”

“…, Freitas et al . , Echaniz‐Laguna & Philippi ). Magnetic resonance imaging (MRI) has become the gold standard for diagnostic imaging of the spine.…”