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A 68-year-old woman gave a 2-month history of progressive partial closure of the right eyelid, subsequently involving the left eyelid, with no other visual symptoms. She had presented 2 years previously with patchy paraesthesia and predominantly distal weakness in the upper limbs, progressing to the feet over 5 days, with absent tendon reflexes and mild distal sensory loss. She had been treated with intravenous immunoglobulin (IVIg; 400 mg/kg daily for 5 days) for presumed Guillain–Barré syndrome and gradually recovered. Four months later she developed deteriorating motor function and lower thoracic back pain—but no change in bladder or bowel function. Investigations confirmed a demyelinating neuropathy, with nerve conduction studies fulfilling electrodiagnostic criteria for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).1 Cerebrospinal fluid was acellular with a protein concentration of 1.19 g/L (normal <0.45). Important normal/negative results included serum protein electrophoresis and immunofixation, serum antineuronal antibodies, MR scan of whole spine, skeletal survey and CT scan of chest, abdomen and pelvis. She …
Contributors DK and LG performed a clinical assessment, examined the patient, compiled the manuscript and approved its final version.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Mark Lawden, Leicester, UK.