Peripheral Polyneuropathy Research Articles

Rewarming from unwitnessed hypothermic cardiac arrest with good neurological recovery using extracorporeal membrane oxygenation.

A 26-year-old man, who was training in bad weather for a mountain ultramarathon, became hypothermic after running for 4h. He deteriorated and was unable to continue. His running partner went for help. The man suffered an unwitnessed hypothermic cardiac arrest. The on-site management and evacuation are described and included the use of intermittent cardiopulmonary resuscitation and a mechanical device during transport. The patient was successfully resuscitated and rewarmed by Extracorporeal Membrane Oxygenation (ECMO) after more than 2h of cardiopulmonary resuscitation. After 14h of ECMO support and five days of ventilation, the patient subsequently made a good neurological recovery. At hospital discharge, he had normal cerebral function, and an improving peripheral polyneuropathy affecting distal limbs, with paraesthesia in both feet and reduced coordination and fine motor skills in both hands.

Formation of Rehabilitation Diagnosis in Patients with Breast Cancer at Stage I of Medical Rehabilitation: Case Report

The article reviews the main complaints of patients with breast cancer depending on the type of antitumor treatment and defines the peculiarities of the basic and additional sets of the International Classification of Functioning (ICF) codes. Aim. To present the clinical experience results of ICF use in making a rehabilitation diagnosis for patients with breast cancer, to discuss the issues and problems that arise when choosing domains in patients receiving various methods of treatment for this disease, to show by the example of a case report the use of ICF when forming a rehabilitation diagnosis in a patient with breast cancer after surgical treatment and anti-tumor drug therapy. Results and discussion. Patients who had undergone the surgical treatment, in the early postoperative period are predominantly characterized by: pain in the arm and shoulder joint, swelling of the arm, limited range of movement in the shoulder joint on the operation side, increased fatigue, difficulties in self-care, irritability, and anxiety. Patients who had eceived radiation therapy complained of skin manifestations – reddening of the skin in the area of radiation exposure and trophic ulcers, as well as complaints of numbness of the fingers and toes, palpitations, a feeling of interruptions in the heart area, frequent changes in blood pressure, which are characteristic signs peripheral polyneuropathy and cardiovascular form of autonomic neuropathy. Distinctive features of patients had being receiving anticancer medication therapy were complaints of disorders in the digestive system, hair loss. According to the complaints of each category of patients, the basic and additional sets of ICF were determined to make a rehabilitation diagnosis. The case report demonstrates the practical application of the basic and the inclusion of additional ICF sets for making a rehabilitation diagnosis for a patient with breast cancer and determining the tactics of rehabilitative measures. Conclusion. The results of the study suggest the importance of reflecting the completeness of all domains of the ICF domains specific for a particular patient, as the aim of rehabilitation is established on the basis of the rehabilitation diagnosis formulated by MDRT specialists.

Role of Sural Sensory Nerve in the Assessment of Type 2 Diabetes Mellitus Peripheral Polyneuropathy in Adults

Diabetes mellitus (DM) is regarded as the most common cause of chronic peripheral neuropathy. It arises when blood sugar levels are high, causing damage to the nerves. In the meantime, the nerve conduction study (NCS) is the gold standard tool to diagnose diabetic polyneuropathy, the sensory nerve of the leg in the calf region is called the sural nerve. It is the continuation of the tibial nerve at this body part.

Dry beriberi after sleeve gastrectomy: An undiagnosed case report.

Introduction and importanceSleeve gastrectomy (SG) is a popular surgery for morbid obesity because of minimal complications, while somewhere uncommon micronutrient deficiencies occur that make problems. One of these rare complications is dry beriberi (BB).Case presentationA 20-year-old girl with obesity that a few months after SG had non-specific symptoms like nausea, vomiting, debilitating weakness, burning, and tingling in her feet, which led to more tests and imaging and confused the physicians. During the next two months, she had a 40 kg weight loss. The critical test that helped diagnosis was Electromyography and Nerve Conduction Velocity (EMG/NCV), which showed subacute axonal sensory-motor polyneuropathy and decreased level of vitamin B1, proved the patient's diagnosis was dray BB.Clinical discussionSG may contribute to vitamin and trace elements deficiency development. One of the micronutrients that deficiencies can disturb the patient is vitamin B1 deficiency. Vitamin B1 deficiencies could be demonstrated with peripheral polyneuropathy, beriberi, or Wernicke-Korsakoff syndrome. Based on decreased vitamin B1 and EMG/NCV results, the diagnosis had been dry beriberi corrected with supplement therapy.ConclusionThiamine deficiency should be suspected in all patients with vomiting, neurological symptoms, and rapid weight loss post-bariatric surgery (BS), even after restrictive surgery. Especially when a patient reports substantial weight loss and vomiting in short order. Hopefully, this case report will make any patient hospitalized with similar conditions evaluated for beriberi and again multivitamin supplementation therapy after SG is emphasized.

Neuromyopathy due to mitochondrial trifunctional protein deficiency caused by novel HADHA mutation

Mitochondrial trifunctional protein deficiency (MTP deficiency or MTPD) is a rare autosomal recessive disorder of oxidation of long-chain fatty acids. It is characterized by severe neonatal manifestations such as cardiomyopathy, hypoglycemia, metabolic acidosis, skeletal myopathy, neuropathy, liver disease, and death. It can also present with mild symptoms such as peripheral polyneuropathy, episodic rhabdomyolysis, and pigmentary retinopathy. Peripheral neuropathy is a known and long-term irreversible complication of MTPD. We report a rare case of a 5-year-old male child with slowly progressive limb weakness; genetic analysis was suggestive of MTPD with novel HADHA gene mutation. The present study comprehensively analyzed the cases, including exome sequencing, to the best of our knowledge, describing the first observation of homozygous novel mutation in the HADHA gene underlying this disorder in India.

Structural insights into Charcot-Marie-Tooth disease-linked mutations in human GDAP1.

Charcot–Marie–Tooth disease (CMT) is the most common inherited peripheral polyneuropathy in humans, and its different subtypes are linked to mutations in dozens of different genes. Mutations in ganglioside‐induced differentiation‐associated protein 1 (GDAP1) cause two types of CMT, demyelinating CMT4A and axonal CMT2K. The GDAP1‐linked CMT genotypes are mainly missense point mutations. Despite clinical profiling and in vivo studies on the mutations, the etiology of GDAP1‐linked CMT is poorly understood. Here, we describe the biochemical and structural properties of the Finnish founding CMT2K mutation H123R and CMT2K‐linked R120W, both of which are autosomal dominant mutations. The disease variant proteins retain close to normal structure and solution behavior, but both present a significant decrease in thermal stability. Using GDAP1 variant crystal structures, we identify a side‐chain interaction network between helices ⍺3, ⍺6, and ⍺7, which is affected by CMT mutations, as well as a hinge in the long helix ⍺6, which is linked to structural flexibility. Structural analysis of GDAP1 indicates that CMT may arise from disruption of specific intra‐ and intermolecular interaction networks, leading to alterations in GDAP1 structure and stability, and, eventually, insufficient motor and sensory neuron function.

Raynaud’s phenomenon and positive antinuclear antibodies as first manifestation of POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes): a case report

BackgroundPOEMS syndrome is a rare paraneoplastic syndrome caused by plasma cell disorder almost always lambda restricted. Secondary Raynaud’s phenomenon is an overlooked skin manifestation of the disease even though it is present in twenty percent of patients. On POEMS syndrome have not been described positive antinuclear antibodies (ANA) and this could lead to a misdiagnosis of autoimmune disease, mainly systemic sclerosis.Case presentationA 47-year-old man presented with color changes on fingertips consistent with biphasic Raynaud’s phenomenon; an antinuclear antibody test was positive (at 1:320 titers in a speckled pattern) with normal nailfold capillaroscopy. Clinical features of systemic sclerosis were absent. Twenty-four months later, the patient presented symmetric sensorimotor demyelinating polyneuropathy, and he was diagnosed with Guillain–Barre syndrome; treatment with intravenous gammaglobulin had an incomplete response. Raynaud’s phenomenon persisted associated with acrocyanosis, white nails, and positive ANA (1:1280 in a nucleolar pattern). POEMS syndrome was suspected, and serum protein electrophoresis (SPEP) was done. The SPEP revealed polyclonal gammopathy, and serum immunofixation showed monoclonal (M)-protein (IgG lambda). Serum vascular endothelial growth factor concentration showed increased levels. The patient was diagnosed with POEMS syndrome, and treatment with lenalidomide and dexamethasone improved the Raynaud’s phenomenon, acrocyanosis, and white nails, but the neurological response was partial.ConclusionsPOEMS syndrome may mimic clinical manifestations of systemic sclerosis v.g. Raynaud’s phenomenon, skin thickening, telangiectasia, and positive ANA. Raynaud’s phenomenon may precede other clinical manifestations of POEMS syndrome by several months. It is necessary to have a high index of suspicion for the diagnosis, especially in patients with peripheral polyneuropathy and monoclonal paraprotein. The significance of positive ANA in this condition is unknown and deserves further investigation.

Lysozyme amyloidosis—a report on a large German cohort and the characterisation of a novel amyloidogenic lysozyme gene variant

Lysozyme-derived (ALys) amyloidosis is a rare type of hereditary amyloidosis. Nine amyloidogenic variants and ∼30 affected families have been described worldwide. The most common manifestations are renal dysfunction, gastrointestinal tract symptoms, and sicca syndrome. We report on the clinical course of ten patients from six families representing one of the largest cohorts published so far. Seven patients carried the W64R variant showing the whole spectrum of ALys-associated symptoms. Two patients—a mother-son pair—carried a novel lysozyme variant, which was associated with nephropathy and peripheral polyneuropathy. In accordance with previous findings, the phenotype resembled within these families but did not correlate with the genotype. To gain insights into the effect of the variants at the molecular level, we analysed the structure of lysozyme and performed comparative computational predictions on aggregation propensity and conformational stability. Our study supports that decreased conformational stability is a key factor for lysozyme variants to be prone to aggregation. In summary, ALys amyloidosis is a very rare, but still heterogeneous disease that can manifest at an early age. Our newly identified lysozyme variant is associated with nephropathy and peripheral polyneuropathy. Further research is needed to understand its pathogenesis and to enable the development of new treatments.

Needle Electromyography in the Acute Phase of Stroke: Correlation With Severity and Muscle Strength: Preliminary Findings.

After the stroke, the development of the second motor neuron degeneration can reduce muscle strength and functional capacity. The aim of this study was to describe the electro-myographic findings in the acute phase of stroke and to correlate them with the severity and muscle strength. Twenty patients were studied in the first 72 hours after stroke. The severity of the lesion was assessed using the National Institutes of Health Stroke Scale (NIHSS), and muscle strength was assessed using the Medical Research Council Scale (MRC). Sensory conduction and motor conduction were studied to exclude peripheral polyneuropathy, radiculopathies, or other neuro-muscular diseases, and electro-myography (EMG) was performed with co-axial needle electrodes in the deltoid, carpal radial extensor, vastus lateralis, and anterior tibialis at rest, slight effort and maximum effort. The associations between qualitative and quantitative variables were studied using the Chi-square test and Fisher's exact test. Among the patients, 40% had abnormal EMG [positive sharp waves (PSWs), fibrillation, fasciculations, and abnormal patterns in maximum effort]. Positive correlations were found between NIHSS and PSW (p = 0.005; r = 0.65) and abnormal EMG (p = 0.017; r = 0.72), and negative correlations were found between MRC and PSW (p = 0.041; r = -0.83) and abnormal EMG (p = 0.027; r = -0.81). It was concluded that the main EMG findings in the acute phase of stroke were the presence of the denervation process and polyphasic motor unit potentials. These changes in EMG were correlated with stroke severity and lower muscle strength.

Change of Fibroblast Growth Factor 21 Level Correlates with the Severity of Diabetic Sensory Polyneuropathy after Six-Week Physical Activity.

Diabetic neuropathy (DN) is a very frequent microvascular complication of type 2 diabetes mellitus (T2DM). Obesity and physical inactivity are well-known risk factors for T2DM. Fibroblast growth factor 21 (FGF21) is a liver-secreted hormone with several beneficial effects on obesity-related metabolic disorders. We aimed to investigate the effect of short-term physical activity on the levels of FGF21, and its correlation with the severity of peripheral sensory polyneuropathy in T2DM patients. Thirty patients with DN were enrolled in the study, compared to age- and gender-matched controls. We conducted a six-week aerobic training program, which meant treadmill and cycle ergometers three times a week. Anthropometric and laboratory parameters were measured for each patient before and after intervention. Serum levels of FGF21, TNF-alpha, irisin, leptin and adiponectin were measured by ELISA. The sensory perception threshold (CPT) was quantitatively measured using Neurometer®. We found significant decreases in BMI, waist circumference, HbA1c and TNF-alpha levels. From baseline to six-week follow-up, FGF21 levels were significantly increased in DN patients. Significant negative correlations were shown between the changes in FGF21 levels and BMI, between changes in FGF21 and the improvement of CPT values, and between the changes in FGF21 and TNF-alpha levels. There was no difference in irisin, adiponectin and leptin levels in DN patients after aerobic training program. The physical activity may increase the level of FGF21 in T2DM patients with neuropathy. Our results highlight the importance of regular physical activity in the treatment of diabetic neuropathy.

Prevention of Peripheral Distal Polyneuropathy in Patients with Diabetes: A Systematic Review.

Background: Diabetic peripheral neuropathy (DPN) is the most frequent chronic complication and is that which generates the highest disability and mortality in diabetes mellitus (DM). As it is currently the only microvascular complication of DM without a specific treatment, prevention is essential. The aim of this study was to determine the most effective preventive strategy to avoid or delay the appearance and/or development of DPN in patients with DM. Methods: A systematic search was carried out in the main health science databases (PubMed, Scopus, CINAHL, PEDro and The Cochrane Library) from 1 January 2010 to 31 August 2020. The study selection was conducted by two independent reviewers and data extraction was performed by the author. The eligibility criteria included randomized clinical trials (RCTs) and cohort studies from RCTs. Results: Eleven studies were selected that included 23,595 participants with DM. The interventions evaluated were intensive or standard glycemic control, the use of drugs to achieve glycemic control, and the promotion of a healthy lifestyle and exercise. Intensive glucose control achieved a significant reduction in the development of DPN in TIDM patients, and lifestyle modifications and exercise achieved it moderately in TIIDM patients. Conclusions: The main preventive strategy for DPN is intensive glycemic control with a target HbA1c < 6% in patients with TIDM and standard control of 7.0–7.9 in patients with TIIDM, incorporating lifestyle modifications.

The Relationship of Nerve Conduction Velocity (NCV) Amplitude with Controlled and Uncontrolled Diabetes Mellitus based on HBA1C in Peripherals Polyneuropathy Patients in Sanglah Hospital

Background: Complications microangiopathy in the field of nerves resulting from diabetes mellitus is diabetic neuropathy. Patients with diabetes mellitus with blood glucose levels that are not regulated well have a 25.6% risk of developing neuropathy. Neuropathy can be diagnosed clinically, the presence of complaints such as numbness, tingling, or burning in the distal extremity, but almost half of patients are asymptomatic, other methods to determine the presence of neuropathy are questionnaires and electrodiagnostic examinations which are the gold standard. The purpose of this study was to find the relationship between the amplitude of nerve conduction velocity (NCV) with controlled and uncontrolled diabetes mellitus based on HBA1c in patients with peripheral diabetic polyneuropathy at Sanglah Hospital. Method: This study was conducted with a case-control analytic design at Sanglah Hospital by taking data retrospectively where patient data were directly taken from January 2021-October 31 2021 Results: There were 40 research subjects where 20 subjects with controlled DM and 20 subjects with uncontrolled DM, 62.5% men, with an age range of 50-60 years, BMI obesity, duration of diagnosis &gt; 3 years where the results obtained were peripheral polyneuropathy conditions. with the results of NCV only found a significant difference in CMAP N Median with p 0.026 and in SNAP with p = 0.035 in SNAP Conclusion: All patients have the result of decreased function of NCV with the highest risk if it is not controlled with HBA1C levels &lt; 7%, there will be the greatest decrease in NCV motor and sensory N. radialis. Keywords: diabetes mellitus, CMAP, HBA1C, NCV, SNAP.

Новые критерии эффективности медицинской реабилитации больных сахарным диабетом, осложненным диабетической нейропатией нижних конечностей

Diabetes mellitus has gone beyond the scope of a common medical problem and is classified as one of the urgent and socially significant problems of mankind. Despite the achievements in the field of diabetes, the urgency of this problem does not decrease, and this is primarily due to the fact that diabetes mellitus has become younger, there has been an increase in the incidence in all age groups. A comprehensive study of patients with diabetes mellitus complicated by peripheral polyneuropathy of the lower extremities was carried out in Kyrgyzstan. The use of new methods of treatment is shown. Normalization of carbohydrate metabolism in patients of the group with the additional use of ozone occurred after 3-4 ozone therapy procedures. Standard therapy in combination with the physiotherapeutic method of treatment with ozone therapy is more effective.

The relation between serum uric acid levels and diabetic peripheral neuropathy in type 2 diabetes in Guilan, north of Iran

BackgroundDiabetic peripheral neuropathy (DPN) is one of the most common chronic microvascular complications in type 2 diabetes mellitus (T2DM). Hence, the present study aimed to investigate the association between Serum Uric Acid (SUA) levels and diabetic peripheral polyneuropathy in patients with type 2 diabetes.MethodsWe performed this case–control study during 2019–2020 on individuals with diabetes referring to the Razi clinic of Rasht, in the north of Iran. Polyneuropathy in patients was assessed based on the Neuropathy Disability Score (NDS), Diabetic neuropathy symptom score (DNS) scoring system, and electromyography (EMG)/nerve conduction velocity (NCV). The inclusion criterion for the control group was normal EMG/NCV. Then, the patients were assessed for SUA level and also laboratory results.ResultsIn total, 230 patients with type 2 diabetes were examined. The mean SUA level in the DPN group was significantly higher compared to the control group (6.72 ± 1.75 vs. 4.57 ± 1.49 mg/dL). With increasing the SUA, the odds of developing neuropathy increased by 2.2 times (OR = 2.2). The risk factors for diabetic polyneuropathy included gender (male) (OR = 0.347), SBP (OR = 1.1), retinopathy (OR = 3.29), and microalbuminuria (OR = 4.44). The chance of developing polyneuropathy in patients with retinopathy was 3.3 times higher than in the control group, it was 4.4 times in microalbuminuria patients.ConclusionElevated SUA level increased the chance of developing peripheral polyneuropathy in a person with type 2 diabetes. SUA levels higher than 5.25 mg / dL expose a person with type 2 diabetes to developing peripheral polyneuropathy.

Gastrocolic Reflex Is Delayed and Diminished in Adults with Type 1 Diabetes.

Constipation is a prevalent gastrointestinal complication in diabetes. The pathophysiology may include neural dysfunction and impaired gastrocolic reflex; however, investigation of the latter has been limited in diabetes. Using the wireless motility capsule, we investigated whether the gastrocolic reflex was impaired in adults with type 1 diabetes compared to healthy. One hundred and four adults with type 1 diabetes underwent investigation with the wireless motility capsule and recorded sleep cycle, eating habits, and bowel movements in a diary. Colonic motility index, contraction amplitudes, time-to-peak, peak motility, and colonic transit time were investigated directly in response to a meal. Diagnosis of peripheral (nerve conduction) and autonomic (orthostatic hypotension) polyneuropathy was verified. In comparison with health, people with diabetes had at the time of ingestion decreased motility index and contraction amplitudes (p < 0.001), prolonged time-to-peak (p = 0.01), and borderline decreased peak motility (p = 0.06), which taken together indicate impaired coordination of the gastrocolic reflex. These features were most prominent in those with concomitant peripheral or autonomic neuropathy. Additionally, they were associated with prolonged colonic transit time (p > 0.01). In type 1 diabetes, the gastrocolic reflex was delayed and diminished and further associated with the presence of neuropathy and constipation. These results suggest that impaired reflex is part of the underlying pathogenesis in the development of constipation.

Shock wave therapy in oncology: in vitro, in vivo, rehabilitation

Conduct an analytical review of the available literature data on the use of ESWT in oncology. A review was conducted, including data from electronic databases: Scopus, Web of Science, MedLine, World Health Organization, The Cochrane Central Register of Controlled Trials, ScienceDirect, US National Library of Medicine National Institutes of Health, PubMed, Google Scholar, elibrary, CyberLeninka, disserCat. The study of ESWT in oncology is carried out in two directions: 1) impact on the tumor with the aim of its disintegration, inhibition of growth, enhancement of the action of radiation and/or chemotherapy; 2) rehabilitation of cancer patients. Shock waves in vitro and in vivo significantly reduce the viability and activate apoptosis of cell lines of osteosarcoma, cancer of the stomach, colon, rectum, bladder, breast, urothelial cancer of the upper urinary tract, adenocarcinoma of the cervix, Burkitt's lymphoma, sarcoma, anaplastic thyroid cancer glands, glioblastoma multiforme. Shock waves also sensitize tumor cells for adjuvant chemotherapy and increase its antitumor activity. The lack of a stimulating effect on a number of malignant tumors in this physical factor makes it possible to conduct ESWT studies in the rehabilitation of cancer patients. The data obtained by a number of authors indicate the clinical efficacy of ESWT in the rehabilitation of patients with erectile dysfunction after radical prostatectomy, with postmastectomy lymphedema of the upper limb, with myofascial pain syndrome after cervical lymph node dissection due to malignant neoplasms of the head and neck, with peripheral polyneuropathy induced by cytostatics. However, in order to develop indications and contraindications for the appointment of ESWT in the rehabilitation of cancer patients, it is not enough just to evaluate its clinical effectiveness; currently absent scientific studies with long-term follow-up of patients who received this method of physiotherapy are needed.

A Case of POEMS Syndrome Previously Diagnosed with Extramedullary Plasmacytoma

POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes) syndrome is a rare multisystem disorder associated with osteosclerotic myeloma. It is characterized by peripheral polyneuropathy, presence of monoclonal plasma cell proliferative disorder, and one or more of the following features – sclerotic bone lesions, Castleman disease, elevated levels of vascular endothelial growth factor, organomegaly, extravascular volume overload, endocrinopathy, skin changes, papilledema, and thrombocytosis. Extramedullary plasmacytoma (EMP) is a rare plasma cell neoplasm that arises in isolated tissues without bone marrow involvement or systemic characteristics of multiple myeloma. Herein, we report a male patient who was previously diagnosed with EMP and later developed POEMS.

Rehabilitation of Vascular Transtibial Amputee Patients with Type 2 Diabetes Mellitus and Peripheral Artery Disease: A Case Report

Introduction: Most lower extremity amputations are currently caused by vascular disorders. Diabetes contributes to two-thirds of all lower extremity amputations, while 6-10% of amputations are due to traumatic injury, and the remainder is due to a tumor. The role of physical medicine and rehabilitation experts is very important in providing an overview of the functional level based on the level of amputation. Case: 66 years old, female, referred from Orthopedic department with diagnosing right below-knee amputation 1 year ago, to be made a prosthesis. She underwent amputation because has an ulcer on the back of her foot that worsens and is always wet. She has diabetes mellitus type 2, diabetic nephropathy, hypertension, and peripheral artery disease that altered her condition. She already could do most of the daily activities and walk independently using a walker in a couple of months after surgery. From the physical examination, we found postural low back pain, limitation of right hip joint range of motion, peripheral polyneuropathy, decreased cardiorespiratory endurance, and less confident MFES that indicate fear of fall in geriatric. A complete geriatric assessment was done. Following the rehabilitation program for 6 months, the patient felt a more fit, full right hip range of motion was obtained. She walked more easily with her prosthesis and experienced improvements in physical function parameters Conclusion: The prosthesis was needed to decrease energy consumption during ambulation. Recommended amputation rehabilitation involves interaction between the health care team and the patient to achieve rehabilitation goals.

Cranial polyneuritis in a dog: Presentation, diagnosis, treatment and outcome

AbstractA 6‐year‐4‐month‐old male entire Dalmatian was referred for acute onset ataxia, obtundation, head pressing, dropped jaw and vertical nystagmus. Neurological examination identified vestibular ataxia, positional left‐sided ventrolateral strabismus, static vertical nystagmus, dropped jaw, ptyalism, inconsistently present bilateral palpebral reflexes, menace responses and gag reflex. Based upon neurological examination, multiple cranial nerves were affected, and cranial polyneuropathy was suspected. Peripheral or central cranial polyneuropathy could not be differentiated at this stage. Forebrain disease could not be excluded considering the dog's clinical signs. MRI of the head identified bilaterally enlarged hyperintense and contrast‐enhancing trigeminal and vestibulocochlear nerves. Cisternal cerebral spinal fluid analysis was normal. Cranial polyneuritis was suspected. Medical management was initiated with an immunosuppressive dose of prednisolone and ciclosporin and an improvement of the dog's clinical signs was observed. This case is the first to describe a diagnostic approach and treatment plan for suspected cranial polyneuritis.

Paraneoplastic Optic Neuropathy as an Initial Clinical Manifestation of Small Cell Lung Cancer. A Case Report

Paraneoplastic optic neuropathy (PON) is a very rare condition. In this study, a case of PON is presented, with the first complaint by the patient being painless vision loss in one eye. In the follow-up of our case, optic neuropathy developed in the fellow eye. Electromyography examination performed due to diffuse body pain and motor loss in the left extremity was compatible with peripheral sensorimotor polyneuropathy. Lung biopsy was planned due to the EMG result and lymphadenopathy detection in thorax computed tomography (CT). The biopsy result of the patient was reported as nonspecific hyperplasia. As the patient’s complaints increased, a paraneoplastic antibody panel was requested and CV2 / CRMP5 antibody was found to be positive. Thereupon, as a result of the repeated biopsy, our patient was diagnosed with small cell lung cancer. We think that paraneoplastic optic neuropathy should be considered in the differential diagnosis in patients of advanced age, smokers, painless subacute vision loss, optic disc swelling, and research in this direction should be insisted on, as in our case.