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NEUROSAE 2018 ANNUAL MEETING EDITION (VOLUME 10, ISSUE 3)
QUESTION 50 OF 100
A 34-year-old woman presents with a 2-week history of tingling in the legs and, more recently, weakness and numbness up to the waist for the past 3 days. She states she had diarrhea for 2 days about a week before the symptoms began, but she attributed it to food poisoning. Examination reveals mild paraparesis with associated sensory loss and diffuse arreflexia. CSF analysis reveals a protein level of 213 mg/dL without a pleocytosis. MRI scans show enhancement of the cauda equina, consistent with acute inflammatory demyelinating polyradiculopathy (AIDP). Which of the following factors is associated with a poor prognosis for symptom recovery?
A. Patient age <40 years
B. Progression of symptoms over 14 days
C. Areflexia in the arms despite lack of weakness
D. Protein >200 mg/dL in CSF
E. Previous diarrheal illness **
** = Your answer
In most patients with AIDP, recovery typically occurs within 4 weeks of symptom onset, although complete recovery may require several months. Up to 15% of patients continue to experience severe disability after acute presentation, but this percentage may be higher in the presence of significant axonal involvement. Other factors that may predict a worse prognosis include rapid worsening of symptoms in the first 7 days after onset, patient age >60 years, the need for mechanical ventilation, or previous infections with cytomegalovirus or a diarrheal illness, which often is due to Campylobacter jejuni.
* Dimachkie MM, Saperstein DS. Acquired immune demyelinating neuropathies. Continuum Lifelong Learning Neurol. 2014;20(5):1241-1260.