Case report – his and hers neurology

Abstract

A 81-year-old retired postal worker who lived with his wife presented with collapse into a chair and a witnessed unresponsive episode. His family also described a reduction in mobility over a ten-year period, with long-standing urinary symptoms, more help needed to dress his lower half and worsening memory. His past medical history included a coronary bypass graft 20 years previously, osteoarthritis, hypertension and poor mobility deemed secondary to severe intermittent claudication. On physical examination, he had peripheral pitting oedema and distal weakness. He had absent reflexes but intact sensation to all modalities. His gait showed markedly decreased stride length and a weakness on dorsiflexion of both feet. Laboratory serum tests were normal except for chronic renal impairment (eGFR 34). A myeloma screen was negative. Admission ECG, CXR and 24 hour ECG tape were also normal. A CTand MRIscan of the brain showed enlarged ventricles in keeping with a degree of cerebral atrophy. MRI of the spine showed multi-level disc bulging with foramenal stenosis but no root compression. CSF sampling showed moderately raised protein only. A diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) was made on a clinical basis and this was confirmed on nerve conduction studies. Intravenous immunoglobulin was given and a six-metre walk test showed an improvement from