Subacute unilateral cranial and cervical polyneuropathies

Abstract

An 82-year-old man presented 6 months prior with a sudden onset of husky voice and painless weakness of his left upper arm progressing over 3 days. He subsequently noticed wasting of the muscles on the left side of his neck and shoulder and sensory loss over the left side of his scalp and neck. There was no history of weight loss, anorexia, cough or haemoptysis. On examination he had an absent gag reflex on the left, wasting and fasciculations of the left side of the tongue with deviation to the left on protrusion (Fig. 1A). There was winging of the left scapula with wasting and weakness of the left trapezius, sternocleidomastoid and deltoid muscles along with marked wasting of the muscles over the left dorsal aspect of the neck (Fig. 1B). There was impaired light touch in the C2–4 dermatome. The power, reflexes and sensory examination were otherwise normal in