A 57-Year-Old Man With Unexplained Difficulty Walking

Heidi Moawad, MD

Disclosures

August 23, 2018

Discussion

The patient has chronic inflammatory demyelinating polyneuropathy (CIDP), also referred to as chronic inflammatory demyelinating polyradiculoneuropathy. Because of the chronic nature of the symptoms, CIDP can present in a manner that is similar to that of other conditions that produce diffuse neurologic symptoms, such as multiple sclerosis, rheumatoid arthritis, and amyotrophic lateral sclerosis.

CIDP is characterized by distal peripheral neuropathy, which manifests as symptoms of motor weakness and sensory disturbances. The disease occurs as a result of demyelination of multiple distal peripheral nerves bilaterally and is almost symmetrical, although some asymmetry to the symptoms and clinical examination findings is usually noted.

Often considered similar to Guillain-Barré syndrome, which is an acute demyelinating polyneuropathy, the biggest difference is that CIDP is a chronic condition. Another important distinction between the two conditions is that Guillain-Barré syndrome involves weakness of the respiratory muscles, which can make the condition life-threatening, whereas CIDP typically does not involve respiratory muscle weakness. Guillain-Barré syndrome is often preceded by an infection, whereas CIDP is not usually preceded by an infection. Patients who have had an episode of Guillain-Barré syndrome may go on to develop CIDP and have recurrent episodes of peripheral nerve demyelination that are characteristic of CIDP; however, subsequent episodes are not typically as severe as the initial Guillain-Barré syndrome presentation.

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