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Abstract Details

Spectrum of Combined Central and Peripheral Demyelination: A Case Report
Autoimmune Neurology
P12 - Poster Session 12 (5:30 PM-6:30 PM)

We highlight a case of a patient who presented to the hospital for shortness of breath and treated for pneumonia. The patient later had worsening lower extremity weakness. Diagnostic work up revealed CCPD.

Current understanding of combined central and peripheral demyelination (CCPD) syndromes is limited. An infection or vaccination may precede symptoms of CCPD.

Case report with analysis.

A sixty-year-old male presented to the emergency department with complaints of subacute worsening shortness of breath, chest pain, and hypoxemia. He was found to have bilateral pulmonary infiltrates and was treated with Rocephin and Zithromax. Neurology was consulted for progressive paraparesis with sensory loss, urinary retention, and constipation. On initial physical exam, patient had mild bilateral lower extremity weakness with intact deep tendon reflexes (DTR). His exam progressively worsened over three days and later revealed more pronounced weakness with 2/5 motor strength in bilateral lower extremities. His DTRs were decreased to 1+ in bilateral patellae and absent in bilateral ankles. Pan-spine magnetic resonance imaging (MRI) demonstrated cord signal changes from cervical spine level 6 through thoracic spine level 9. Cerebrospinal fluid analysis showed: 152 protein, 68 glucose, and 14 white blood cells with lymphocytic predominance. Nerve conduction studies (NCS) showed evidence of patchy demyelinating sensory motor peripheral polyneuropathy with distal denervation in lower extremities concerning for acute inflammatory demyelinating polyneuropathy (AIDP). Neuromyelitis Optica/Aquaporin-4 (NMO/AQP4) antibodies were positive. He was treated with high dose steroid for 5 days and later received intravenous immunoglobulin (IVIG) with minimal 
improvement. The patient was discharged to an acute rehabilitation facility for aggressive physical therapy.

In rare instances, central and peripheral demyelination may coexist. Patients with CCPD tend to have a poor clinical outcome to steroids and IVIG. Hence, early recognition is imperative and plan for aggressive rehabilitation to prepare patients for outcomes and expected recovery.

Sukriye Damla Kara, MD (University of Mississippi Medical Center)
Dr. Kara has nothing to disclose.
No disclosure on file
Maryam Zulfiqar, MD (Medical University of South Carolina) Dr. Zulfiqar has nothing to disclose.
Clara Thiel, MD (University of Mississippi Medical Center) Dr. Thiel has nothing to disclose.