Acute Symmetric Polyneuropathy

Yoshinosuke Shimamura MD, Jeffrey Levine MD, Joey Lopreiato MD

March 18, 2016

A 24 year-old male presented to the emergency room complaining of progressive sensory loss in bilateral lower extremities for eight days. The patient reported that he had a mild upper respiratory infection two weeks prior to this presentation. Eight days prior to the presentation, he started to feel numbness and tingling sensations in both feet. On the next day, he began to have difficulty discerning hot and cold temperatures and textures of surfaces. The symptoms progressed up to his waist four days prior to his presentation. Past medical history was notable for right parenchymal temporal lobe hemorrhage secondary to head trauma seven months prior. His mother has systemic lupus erythematosus. On neurological examination, cranial nerves were grossly intact, but there was decreased sensation in all modalities, including light touch, temperature, and pin-prick, from toes to the level of the umbilicus. Sensory loss was most prominent in the feet, improving in an ascending fashion. Similar presentation was found in vibration although it was denser in the trunk region than other modalities. Other exams, including motor function, coordination, gait, and reflexes were grossly intact. On admission, the blood work was only significant for WBC 13,700 /mm3 and C-reactive protein 2.23 IU/dl. TSH and vitamin B12 level were within normal range. RPR and serum Aquaporin-4 antibody were negative. Cerebrospinal fluid analysis showed white blood cell 13 /mm3 (monocytes 99%), glucose 62 mg/dl, and protein 31 mg/dl, oligoclonal bands were not detected. Plain computed tomography of the head and spine only revealed residual parenchymal hemorrhage in the right temporal lobe. On MRI of the spine, there was a high-intensity area seen in C5-C6 (Figure. 1).

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Brief Biography

Yoshinosuke Shimamura MD
Chief Fellow, Japanese medical fellow program, United States Naval Hospital Yokosuka, Japan