day for neuro-2 - stefan78

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A 38-year-old man comes to the office because of paresthesias in his feet that began approximately 8 months ago. He now also has bilateral foot drop and weakness of the right hand. On examination, he has severe weakness in the foot dorsiflexors bilaterally and moderate weakness of foot eversion, inversion, and plantar flexion. He has mild weakness of hip flexion and is unable to rise from a chair without using his arms. There is also weakness in the ulnar-innervated hand muscles, slightly more pronounced on the right than on the left. There are no obtainable reflexes, and he has moderate proprioceptive loss in the toes.
Which of the following is the most likely diagnosis?
A. Guillain-Barré syndrome
B. Chronic inflammatory demyelinating polyneuropathy
C. Polymyositis
D. Myasthenia gravis

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b,,,,

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b?

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Ans B
The diagnostic features of chronic inflammatory demyelinating polyneuropathy include roughly symmetric weakness and sensory loss progressing over at least 2 months, with evidence of segmental demyelination on nerve conduction studies. Although results of electrodiagnostic testing are not given in this case, chronic inflammatory demyelinating polyneuropathy is the most likely diagnosis of the options given. Polymyositis and myasthenia gravis would not produce sensory signs or symptoms. The progression of symptoms over 8 months is too long for Guillain-Barré syndrome, which evolves over 4 to 6 weeks.

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BB