Category: Clinical Sciences/Health Conditions
Case Diagnosis: SCD with AIDP
Case Description: A 28-year old male presented to the hospital with progressive paresis of his extremities, bilateral lower extremity pain and with recent falls at home. He reported an upper respiratory tract infection one month prior to presentation. Muscle testing revealed ⅘ strength with bilateral hip flexion and in the upper extremities with 3+ patellar reflexes. Cerebrospinal fluid analysis showed total protein 70, myelin basic protein 7.3 and no white cells which was consistent with acute inflammatory demyelinating polyneuropathy (AIDP). Magnetic Resonance Imaging of Cervical spine showed abnormal cord signal in the bilateral dorsal columns consistent with subacute combined degeneration (SCD). Patient received five plasmapheresis treatments and started on vitamin B12 supplementation due to low levels. He was transferred to inpatient rehabilitation and successfully completed his program and was discharged at the modified independent level.
Discussions: SCD affects the dorsal and lateral white matter of the spinal cord due to a vitamin B12 deficiency. Supplementation leads to improvement in muscle weakness, paresthesias and sensory ataxia. AIDP is characterized by an immune response directed towards the myelin of the peripheral nervous system caused by a preceding infection. Symptoms include progressive symmetric muscle weakness with absent or depressed deep tendon reflexes. In this report, both the central and peripheral nervous systems were affected and prompt treatment was key to halt disease progression. This allowed the patient to participate in an inpatient rehabilitation program which was an integral part of this functional recovery. The patient required minimum assistance with a wheeled walker prior to his inpatient rehabilitation admission.
Conclusions: This case highlights the importance of participating in inpatient rehabilitation for patients with SCD with superimposed AIDP. Early identification of these disorders is key as delay in treatment affects patient prognosis and functional recovery.
Alexandre Mazar– PMR resident, Beaumot Hospital-Taylor
Melissa Kawa– Faculty, Beaumont Hospital-Taylor
Jared McCallum– Resident Physician, Beaumont Hospital-Taylor Physical Medicine and Rehabilitation
Hashem Zokary– PMR resident, Beaumont Hospital Taylor
Jeffry Mercado– Resident Physician, Beaumont Hospital-Taylor Physical Medicine and Rehabilitation
Usman Ashraf– Resident Physician, Beaumont Hospital-Taylor Physical Medicine and Rehabilitation