83. Hyperreflexia in acute motor sensory axonal neuropathy: A case report

Abstract

Guillain-Barre diagnostic criteria are the presence of acute, symmetric, progressive flaccid paralysis and areflexia, although cases of acute motor axonal neuropathy with increased deep tendon reflexes (DTRs) have been described. We report a patient with Acute Motor Sensory Axonal Neuropathy (AMSAN) with increased DTRs. A 48-year-old male presented with a two-day history of progressive acute lower limbs weakness and imbalance, following a flu-like syndrome. Neurological examination revealed ascending weakness, hyperactive DTRs, impairment of deep sensation and sensory ataxia. Spine magnetic resonance imaging and cerebrospinal fluid examination were normal. Nerve conduction study (NCS) showed a reduction of the sensory and motor action potentials amplitude with normal distal latencies and conduction velocities. A decreased H reflex threshold and high soleus H/M amplitude ratio (>0.7) were found. The patient was treated with intravenous immunoglobulins with progressive improvement. Repeat NCS, performed 10 and 21 days after symptoms onset, confirmed a sensory motor axonal neuropathy. Hyperreflexia has been rarely reported in AMSAN patients. As a possible cause of hyperreflexia, we hypothesized a selective involvement of the sensory Ia fibers, associated with dysfunction of spinal inhibitory interneurons.