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CIDP presenting as recurrent severe back pain without weakness or sensory loss
  1. Dirk Bäumer1,
  2. David James Grant2,
  3. Ravi Knight3,
  4. Camilla Buckley4,
  5. David Bennett4,
  6. Simon Rinaldi4
  1. 1Wessex Neurological Centre, University Hospital Southampton, Southampton, UK
  2. 2Department of Neuroradiology, John Radcliffe Hospital, Oxford, UK
  3. 3Department of Clinical Neurophysiology, John Radcliffe Hospital, Oxford, UK
  4. 4Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Dr Simon Rinaldi, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; simon.rinaldi{at}nhs.net

Abstract

A 71-year-old woman presented with severe back pain, limb weakness and cranial nerve dysfunction associated with high cerebrospinal fluid (CSF) protein; we diagnosed Guillain-Barré syndrome and her symptoms completely resolved after intravenous immunoglobulin. Over the next 4 years, she had three further episodes of excruciating back pain accompanied by raised CSF protein, but without weakness, sensory loss, or abnormalities in routine nerve conduction studies. Sensory evoked potentials suggested proximal demyelination and lumbosacral plexus imaging suggested inflammation. We argue that this is a relapsing proximal polyradiculoneuropathy on the spectrum of chronic inflammatory demyelinating polyradiculoneuropathy.

  • NEUROPATHY
  • NEUROIMMUNOLOGY
  • GUILLAIN-BARRE SYNDROME

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Footnotes

  • Contributors DiB wrote the paper. DJG created the MRI figure, reviewed and edited the manuscript. RK created the neurophysiology figure, reviewed and edited the manuscript. CB supervised the patient's care and edited the manuscript. DaB conceived the paper and edited the manuscript. SR conceived the paper and edited the manuscript and figures.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Robert Hadden, London, UK.

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    Phil E M Smith Geraint N Fuller