Disclosures: Angelo M. Allos, MD: No financial relationships or conflicts of interest

Case Description: The patient experienced progressive, ascending lower extremity weakness with numbness and paresthesias 6 weeks following hospitalization for a urinary tract infection. He presented to the emergency department after inability to ambulate for 3 days. Symptoms progressed to involve a sensory level at T10 and bilateral lower extremity paraparesis.

Setting: Tertiary Hospital

Patient: 73 year old male with bilateral, ascending, lower extremity weakness and paresthesias. Assessment/

Results: Diagnosed clinically with acute inflammatory demyelinating polyneuropathy (AIDP), the patient was started prophylactically on intravenous immunoglobulin (IVIG) for 5 days. Lumbar puncture with cerebral spinal fluid (CSF) analysis showed equivocal CFS markers. First electromyography (EMG) showed sensorimotor demyelinating and to lesser extent, axonal neuropathy with absent and/or delayed F waves with mild temporal dispersion. Following little improvement, follow up magnetic resonance imaging (MRI) of thoracic and lumbar spine revealed enhancement of cauda equina roots and enhancement within distal spinal cord from T9-L1, consistent with a transverse myelitis (TM), or other demyelinating etiologies. High dose steroid therapy was initiated to treat TM, as IVIG therapy was continued. Repeat EMG showed similar findings to the prior EMG but now with active denervation of the distal right lower extremity muscles along with an absent right peroneal nerve study. Rehabilitation and functional process was then hastened as patient experienced significant bilateral thigh hematomas believed to be complication from EMG needle exam.

Discussion: There have been very few clinical cases of acute inflammatory demyelinating polyneuropathy/transverse myelitis overlap syndrome that have been described in the literature with similar patient demographics, presenting symptoms, radiographic evidence, and clinical course outcomes.

Conclusion: Most patients with AIDP improve with appropriate treatment and rehabilitation. Patients who fail to improve should be evaluated for other etiologies of weakness. EMG along with focused imaging may help indicate whether more than once process may be occurring to limit a patients ability to recover.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-inflammatory-demyelinating-polyneuropathy-and-acute-transverse-myelitis-overlap-syndrome-a-case-report/