Disclosures: Jason Cullen, MD: No financial relationships or conflicts of interest

Case Diagnosis: Neuromuscular Ultrasound in the Diagnosis and Treatment Monitoring of a Pediatric Rehabilitation Patient with new onset CIDP: A Case Report

Case Description: A 17-year-old female with history of a poorly characterized demyelinating longstanding polyneuropathy was admitted to a pediatric rehabilitation unit from an outside hospital with and admitting diagnosis of conversion disorder. She had a history of sudden onset bilateral lower extremity weakness and loss of sensation. Patient was previously ambulatory with normal sensation. The patient’s mother questioned the diagnosis of conversion disorder and the patient had no visible response to painful stimuli in the feet. The differential was reopened, and further workup was initiated. MRI of lumbar spine showed nerve root enhancement. Electrodiagnostic testing showed a severe demyelinating polyneuropathy with possible conduction block. Lumbar puncture was positive for albuminocytologic dissociation. Neuromuscular ultrasound (NMUS) was significant for multifocal nerve enlargement consistent with peripheral segmental process.

Setting: Pediatric Inpatient Rehab UnitAssessment/

Results: By discharge, the patient was able to ambulate with contact guard assistance (she was Max assist at admission) and was back to her motor baseline. NMUS was performed again after IVIG which showed improvement in the right fibular nerve and right tibial nerve.

Discussion: Based on these results, the patient was diagnosed with CIPD and was started on 2g/kg of IVIG for 2 days. After IVIG treatments were completed motor function and strength in lower extremities began to show improvement

Conclusion: It is important that pediatric rehabilitation specialists question conversion disorder especially when parents also question the diagnosis and the workup prior to admission was not exhaustive. NMUS is an emerging modality for distinguishing segmental and uniform demyelinating conditions in the pediatric population. It also may be a promising modality to monitor the response of acquired polyneuropathies to immune modulating treatments.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/neuromuscular-ultrasound-beneficial-in-the-diagnosis-and-treatment-monitoring-of-new-onset-cidp/